Medicaid was created on July 30, 1965 through Title XIX of the Social Security Act. Each state administers its own Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

Medicaid is the name chosen by the Wyoming Department of Health for its Medicaid program. Medicaid is jointly funded by the federal and state government. The program is designed to pay for medically necessary health care services for low-income children and families and aged, blind and disabled persons.

The Wyoming Department of Health (WDH) is the state agency designated to administer Medicaid. The Department of Health contracts with the Wyoming Department of Health Customer Service Center to conduct eligibility determination for Medicaid.

Current Policy Effective Date: February 1, 2026

Date Last Reviewed: November 23, 2022

Previous Policy: December 1, 2022

POL M103: ELIGIBLE PERSONS

1. Consider the following persons potentially eligible for medical assistance:

Individuals who meet all Family Care requirements (42 CFR 435.110).

Individuals who meet all Family Care eligibility requirements except for an increase in earned income or child support (42 CFR 435.112, 42 CFR 435.115). Individuals referred by the Wyoming Breast and Cervical Cancer Early Detection Program requiring treatment for breast or cervical cancer whose income is less than or equal to 250% FPL ( 42 CFR 435.213 and Social Security Act§ 1902(a)(10)(A)(ii)(xviii).

Pregnant women (42 CFR 435.201, 42 CFR 435.116).

Children zero through the age of five whose family income is less than or equal to 154% of the FPL (42 CFR 435.118).

Children age six through the age of 18 whose family income is less than or equal to 133% FPL (42 CFR 435.118).

Children zero through the age of 18 who are covered by Medicare but meet the criteria of Child Zero through the age of five or Child Age six through the age of 18 (42 CFR 435.116).

Newborns (42 CFR 435.117): Born to a woman who is receiving medical assistance in the month of the birth, including Emergency Services for Aliens. OR Born to a woman who applies after the birth of the baby and in determining retroactive eligibility the mother is found to be eligible for medical assistance, including Emergency Services for Aliens.

Children in foster care (42 CFR 435.145).

Adopted children under a Title IV-E or State Subsidized Adoption agreement with DFS (42 CFR 435.145).

Elderly/disabled persons who reside in a Medicaid approved medical institution/hospital (Nursing Home) (42 CFR 435.236).

Individuals placed in the Geriatric Hall at the State Hospital in Evanston.

Individuals who meet 30 consecutive days of Inpatient Hospital Care (42 CFR 435.236).

Individuals age 19 or older who require Home and Community Based Services (HCBS), (Community Choices Waiver) under a federal waiver (42 CFR 435.217).

Individuals who require Home and Community Based Services (HCBS )(Comprehensive, Support, Acquired Brain Injury, and Children's Mental Health) under a federal waiver (42 CFR 435.217).

Individuals who are terminally ill and elect Hospice Care (42 CFR 435.236).

Individuals entitled to Medicare who have income of less than or equal to 135% FPL.

Individuals infected with tuberculosis. (42 CFR 435.215).

Individuals who incurred medical bills prior to the month of application may be eligible for retroactive medical assistance.

Employed individuals, age 16 through age 64, who are in receipt of Social Security disability payments, or have been determined disabled by the Social Security Administration, and whose income is less than or equal to 300% CAP (W.S. 42-4-115, -116) (Employed Individuals with Disabilities).

Individuals receiving SSI (42 CFR 435.120).

Individuals who lose SSI benefits due to the entitlement of SSA Widow/Widower benefits (42 CFR 435.137 - .138).

Individuals who were entitled to RSDI and eligible for and received SSI benefits concurrently but have lost SSI (PICKLE Program) (42 CFR 435.135).

Individuals age 18 or older and disabled prior to age 22 (Disabled Adult Child).

Individuals who are disabled or blind and are SSI eligible except for earned income (1619).

Individuals who are SSI eligible but do not receive a payment because they are in a licensed medical institution (EO1).

Defining Requirement: See Above

A & A - see Aid and Attendance.

AFDC (Aid to Families with Dependent Children) - A program in existence prior to 1/2/97 designed to provide financial assistance to children in need due to absence, unemployment of both parents or incapacity of one or both parents.

ARW - (Administrative Rules of Wyoming) - The Secretary of State's Office is the repository for rules and regulations, and provides this centralized system to promote transparency and ease of access to rules by state agencies and the public . Individual agencies who have rule making authority are responsible for the promulgation and content of rules and regulations.

ASVI (Alien Status Verification Index) - T he automated database maintained by the Immigration and Naturalization Service (INS) which may be accessed by State agencies to verify immigration status.

Absence -

A. Continued absence - when the parent is physically away from the home and is not exercising parental care and control, cannot be counted on to help plan the care and control of the child and the return to the home is not expected for at least 30 days (see Care and Control).

B. Temporary absence - When a client leaves the state with the intent to return to Wyoming within three months or meets the conditions specified in M601 or M605

Absent parent - any parent who is not providing care and control of the child(ren) or who cannot be counted on to function in the planning for the physical care, guidance and maintenance of the child(ren).

Access -

A. Ability, or potential ability, to obtain or make use of a resource or income;

B. Access is either restricted (requires the signature of another person or specifies the condition of disposal) or unrestricted (no other signature is required or condition imposed). (see Available)

Achieving a Better Life Experience (ABLE) Account - Type of tax‐advantaged account that an eligible individual can use to save funds for the Qualified Disability Expenses, who was blind or disabled before age 26. An eligible individual can be the designated beneficiary of only one ABLE account, which must be administered by a qualified ABLE program. Wyoming has not approved these accounts to be established in our state. However; this does not exclude Wyoming Medicaid from exempting an ABLE account from a state who has approved ABLE accounts in their state.

A. Qualified Disability Expenses - in general but not limit to education, housing, transportation, employment training and support, assistive technology and related services, health, prevention and wellness, financial management and administrative services, legal fees, expenses for ABLE account oversight and monitoring, funeral and burial; and basic living expenses.

B. Qualified Disability Expense ﴾QDE﴿ for housing - Housing expenses for purposes of an ABLE account are payments for mortgage ﴾including property insurance required by the mortgage holder﴿; real property taxes; rent; Heating fuel; Gas; electricity; water; sewer; or garbage removal.

Adequate notice - see Notice of adverse action.

Administrative hearing/Disqualification Hearing - a formal hearing conducted within established legal proceedings with a duly appointed hearing officer.

Adult - a person age 18 or older or a person under age 18 who meets the Wyoming emancipation laws.

Adverse action - a decision to deny, decrease or terminate the benefits.

Aged - A person 65 years of age or older.

Aged, Blind and Disabled – applies to individuals in need of professional care provided at home, in a nursing home, hospital or intermediate care facility for the mentally retarded. These groups are Nursing Home, HCBS, TB, Hospice, Inpatient Hospital Care, EID, QMB/SLMB, and the SSI Groups.

Agency error (AG) - an incorrect action or failure to take action by the Agency or a contractor of the Agency .

Aid and Attendance (A & A) - optional financial assistance available from the Veteran’s Administration (VA) for an applicant or recipient receiving care in a licensed and certified Medicaid facility as determined by WDH.

Alimony - see Support.

Annuity - An annuity is a contract or agreement where an individual receives fixed, non variable payments on an investment for a lifetime or a specified number of years. A commercial (non-employment related) annuity purchased by or for an individual using that individuals assets will be considered an available resource unless it meets exemption criteria outlined in Table 8 .

Applicant - a person, including an authorized representative, who expresses verbally or in writing a desire to make application for benefits and all individuals included in a completed, signed and filed application.

Application - the form on which a person indicates, in writing, the desire to receive assistance, provides information necessary for determining eligibility and informs the client of her/his rights and responsibilities.

Appointment of Conservator - the legal document appointing a conservator to care and manage the affairs of another person.

Appointment of Guardianship - the legal document appointing a guardian to care and manage the affairs of another person.

Assessment -

A. The act of evaluating a person, condition, resources or income.

B. For Medicaid, a determination of the total combined resources available to a married couple when one spouse enters a medical institution and the other spouse continues to live in the community.

Assignment of rights - Any assignment of the rights to support, or any assignment of rights to medical support and to payment for medical care from any third party. This assignment includes child and spousal support and is a condition of eligibility of POWER or Title IV Part E, Foster Care. This allows the state to retain support payments as partial reimbursement of public assistance expenditures made on behalf of the custodial parent and/or the child(ren).

Assistance Unit - consists of a person or persons who are living or traveling together and have a financial responsibility for one another.

Available - income and resources are considered when actually obtainable and when the applicant/recipient has legal interest in a liquidated sum and has the legal ability to make such sum available for support and maintenance. (see Access)

Average private pay rate - the average statewide cost of care for nursing facility services as determined by WDH.

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BENDEX - Social Security Administration's Beneficiary Data Exchange System which provides the amount of RSDI benefits paid to people entered on the system.

BIA (Bureau of Indian Affairs) - an agency within the Department of Interior.

Barrier to sale - there is an inherent legal restriction on the right to sell, convey or transfer the client's share or ownership of a resource.

Beneficiary - an individual having a present or future interest, vested or contingent, in the income from or principal of a trust, also used to designate recipients of Social Security benefits.

Best estimate - the Benefit Specialist's best determination based on knowledge of past, current and future case circumstances which accurately reflects all facts known to the Benefit Specialist at the time.

Blind - an individual receiving benefits for the blind.

Blind work expense exclusion - an amount disregarded for items necessary to enable the blind person to work, including but not limited to, attendant care for transportation, durable medical equipment or prosthetic devices.

Bona fide -

A. For burial, a trust, contract or agreement specified for that express purpose and there cannot be other funds or items designated for burial;

B. An offer made in good faith without fraud or deceit;

C. A bona fide loan is one where there is a written agreement to repay the loan.

Bona fide effort to sell - the act of putting property up for sale at a reasonable price and providing verification of same.

Break-in-aid - a period of one or more months in which a client is not eligible and does not receive assistance.

Burial fund -

A. A resource specifically designated for burial of a specified person;

B. Bank account, life insurance policy or written agreement with a funeral home specifically designated for burial of a specified person and not commingled with funds not set aside for burial.

Burial plot - a grave site, the value of which may include opening and closing costs, a vault, crypt, urn, grave marker, etc. (aka burial space item)

Burial space item - burial containers, burial plot, casket, crypt, gravesite, arrangements for the opening and closing costs, headstone, markers or plaques, mausoleum, urn, niche or other repository customarily and traditionally used for the deceased bodily remains. A contract for care and maintenance of the gravesite, sometimes referred to as endowment or perpetual care, can be excluded as a burial space.

Business expenses - for self-employment, the costs directly related to the production of goods or services provided by the operation which are then subtracted from the gross income to determine the net income.

Buy-in - When Medicaid pays the Part A or Part B Medicare premium for the client, that process is called Buy-in.

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COLA - cost of living increase.

CPS (Child Protective Services) - child welfare services performed by persons legally responsible for investigating suspected cases of child abuse and neglect and intervening in verified cases.

Care and control - when a parent or caretaker relative can be counted on to function in planning for and/or is giving the child(ren) physical care, guidance and maintenance as follows:

A. Guidance - parental participation in the responsibility for the child's development. Such participation includes, but is not limited to, attending school conferences, disciplining the child, participating in decisions concerning the child's well-being and involvement in the child's extracurricular activities.

B. Maintenance - typically synonymous with "support" as in provision of necessities such as food, clothing and shelter.

C. Physical care - providing continuous care for the child by performing tasks required in the child's daily life such as, but not limited to, bathing, feeding, dressing, assuring medical attention is received by the child, preparing meals, supervising the child's activities and assisting with other physical care needs.

Caretaker - an adult who may or may not be related to the Medicaid client and who is exercising the care and control of the Medicaid client .

Caretaker relative - a person who meets the definition of a relative and is exercising the day-to-day care and control of the child(ren).

Case manager (CM) - the individual designing and implementing the plan of care for Long Term Care or Developmentally Disabled clients who are receiving Home and Community Based Waiver Services.

Case record - includes the applicant's or recipient's case file and the information contained in WES.

Cash surrender value (CSV) - see Value.

Cash value - see Value.

Categorically eligible – applicants who are receiving assistance from SSI are automatically eligible.

Categorically needy - an individual required by federal law to be provided with medical services.

Change in circumstance - a change which affects the ongoing eligibility/benefit.

Child - a dependent between birth and 18 years of age who is not an emancipated minor or a minor parent.

Children’s Group - children zero through the age of five, six through the age of 18, Newborn and Foster children.

Claim - an eligibility system identification number which is made up of one or more overpayment months.

Claim number - the Social Security number (SSN) plus one or two alpha characters which indicate the primary beneficiary, the type of benefits paid and the designated recipient of the benefits.

Client error (CL) - a misunderstanding or unintended error on the part of the client .

Card management system (CMS) - the computer system used to perform various EBT functions.

Collateral contact - a verbal or interface verification of the circumstances of a Medicaid applicant or client by a knowledgeable person outside the household .

Color of law (aka Permanently Residing Under Color of Law [PRUCOL]) - used by the USCIS and applies to immigrants who are living in the U.S. with the knowledge and permission of the USCIS and whose departure from the U.S. the USCIS does not contemplate enforcing. Immigrant who entered the U.S.:

A. Lawfully in a status other than lawful permanent resident and who are assumed to be here permanently without being granted permanent resident status; or

B. Unlawfully but have resided here continuously since 1/1/72.

Commingled - a financial account in which exempt and nonexempt funds are mixed together.

Common Law Marriage - is one in which the couple lives together for a period of time and holds themselves out to friends, family and the community as "being married ," but without ever going through a formal ceremony or getting a marriage license. This is not recognized as a legal marriage in the State of Wyoming. However, Wyoming recognizes common-law marriages when entered into in other states or nations that recognizes common-law marriage. Refer to Table 5B for required documentation to prove common-law marriage.

Community spouse - a spouse who lives in a community, even when s/he is receiving HCBS benefits, whether inside or outside the state of Wyoming, when her/his married partner lives in a swing bed, nursing home facility or receives HCBS or Hospice services. If a spouse is living in a medical institution or nursing facility, they are not considered a community spouse.

Concurrent - occurring simultaneously or at the same time.

Confidentiality - the limitation of the use and disclosure of applicant and recipient information.

Conservator - a person designated by a legal document to take over and protect the interests of an individual whom is unable to manage her/his own affairs.

Continued absence - see Absence.

Continuous period - consecutive days of care in a medical institution.

Contribution - a voluntary or mandatory monetary or in-kind grant or aid provided by another person(s) which is not repayment for goods or services and is not given because of a legal obligation on the giver's part.

Contract for Deed – a contract between a seller and buyer of real property in which the seller provides financing to buy the property for an agreed-upon purchase price and the buyer repays the loan in installments

Cooperate - to comply with child support activities for adults under Family Care. Third party liability cooperation is required for all adults receiving Medicaid.

Cooperation - a client is working with the Child Support Authority (CSA) to establish medical support.

Cost of nursing facility services - the average statewide private pay rate for nursing facility services as of the previous 1/1 as determined by WDH.

Countable income - see Income.

Court of appropriate jurisdiction - a district, county or small claims court as determined by the amount of the overpayment, the circumstances of the case and the advice of legal counsel.

Court order - an order issued by the court and used by CSA to determine necessary enforcement action to collect a support obligation.

Current market value (CMV) - see Value.

Current month - see Month.

Custodian - an individual who has been appointed by the court to care for a person as reflected in a court order.

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DAC - Disabled Adult Child age 18 or older who was receiving SSI due to a disability or blindness prior to her/his 22nd birthday.

DDS (Disability Determination Services) - a team composed of physicians/psychologists and disability examiners that determines whether or not an individual is disabled for SSA.

DFS - Department of Family Services

DVR (Division of Vocational Rehabilitation) - a division within the Wyoming Department of Workforce Services that offers services to assist in reaching employment goals agreed to by the agency and their client .

DWS (Department of Workforce Services) - the Department responsible for delivering services through public-private partnerships and a statewide network of job centers.

Date of action - the day the benefit will be issued, increased, reduced, denied or terminated. The date an action will be effective.

Date of application - the date the signed application is received and date stamped in by WDH or designated representative.

Date of discovery – the date the potential overpayment is identified by the eligibility worker.

Date of eligibility - the day benefits are required to begin.

Deem - to consider the income and resources of one person as the income and resources of a second person whether or not they are actually available.

Dependent child - see Child.

Dependent deduction - the difference between the federal SSI rate for the single person standard and the couple standard.

Developmentally disabled (DD) - one who is experiencing significant sub-average physical/emotional/mental functioning as verified by a medical professional or the WDH.

Disabled - A person with a medical determination to receive disability benefits paid through SSA or Railroad Retirement because of a disability considered to be permanent. This determination can also be made by WDH.

Disregard - an allowable deduction from earned or unearned income.

Distribution - a payment, in cash, from a trust to or for the benefit of the beneficiary or a third party.

Documentary evidence error (DE) - an error caused by an applicant or client when at least two written documents are in the case file which substantiate the client willfully and knowingly failed to report or reported incorrectly .

Dual Eligible - A client that is currently enrolled in both Medicare and Medicaid is considered to be dual eligible.

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E01 - individuals who are SSI eligible but do not receive a payment as they are in a licensed medical institution.

EID (Employed Individual with Disabilities) - the program allows a low-income, working disabled individual between age 16 up to age 65 to continue to work and purchase medical coverage under the Medicaid work incentives improvement option.

EITC (Earned Income Tax Credit) - an amount of money either deducted from the taxes owed or paid as a refund resulting from filing a Form 1040 or 1040A tax return for a calendar year.

Earned income - see Income.

Edmund's Automobile Valuation Guide - the internet site which provides a used car value guide.

Elderly - a person who is 65 years of age or older (aka Aged).

Eligibility factor - a specified condition a client must meet to qualify or receive benefits.

Emancipation - the condition of being freed from parental care and control resulting from one of the following:

A. Lawfully recognized marriage.

B. Reaching the age of majority (age 18).

C. Military service.

D. Having received a declaration of emancipation pursuant to W.S. 14-1- 202 (See Financially Responsible).

Employment - an activity in which an individual works for wages.

Encumbrance - a claim or legal debt(s) against a resource which must be paid when the resource is sold and is supported by a written document.

Equity value - see Value.

Essential person - individual identified as essential to the welfare of the client by the Social Security Administration prior to the implementation of the SSI program in 1974.

Estate - resources and liabilities left by a person at death.

Ex Parte Renewal Process - The process of renewing Medicaid eligibility for beneficiaries based on reliable information contained in the beneficiary's account or other more current information available to the agency without requiring information from the beneficiary.

Exempt - a category of income, resources or circumstances not subject to program policy or limits and is not counted for eligibility purposes.

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FICA (Federal Insured Contribution Act) - commonly known as the Social Security contribution deducted from wages and used for RSDI payments.

FPL (Federal Poverty Level) - guidelines for poverty level established annually by the Federal Office of Management and Budget.

Face value (FV) - see Value.

Facility (Nursing Facility) - a nursing home is more of a permanent residence for people in need of 24/7 care, while a skilled nursing facility is a temporary resience for patients undergoing medically necessary rehabilitation treatment.

Fair market value (FMV) - see Value.

Family care income standard - the maximum income, based on the number of members in a household unit, allowed for medical assistance.

Family care program - medical coverage for adults, including four or twelve month extended coverage.

Fee-simple - An interest in land that, being the broadest property interest allowed by law, endures until the current holder dies without heirs.

Financially responsible - answerable or liable by law for providing the funds to meet the needs of a spouse and/or child(ren) and, for medical assistance, the needs of an unborn (See Emancipation).

Fixed residence - a home or place in which an individual has or intends to live for a specific length of time.

Fluctuating income - see Income.

Foster child - a child who has been placed in DFS Custody, Tribal Custody, or in an approved/licensed facility.

Fractional Interest - also known as fractional ownership, is a way of expressing percentage-based ownership of a piece of real property. See Majority Owners and Minority Owners.

Fraud - documented misrepresentation, concealment or nondisclosure of information pertaining to an eligibility factor to obtain a performance payment, remain eligible for payment or to avoid a decrease in payment.

Full-time employment - see Employment.

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Garnishment - a legal withholding of a specified sum from wages to satisfy a creditor.

General price list - summary from a mortician itemizing costs of goods and services for a burial or cremation.

Goldberg/Kelly - a Supreme Court decision requiring a client be given written notice prior to reduction, suspension or termination of SSI and allows payments to continue at the previous rate until a decision is made after a timely appeal is filed.

Good cause - a specified reason based on accepted standards supporting the individual's action and thereby eliminates the penalty which normally a sanction is imposed.

Grantor - the person giving the Trustee the legal right to manage a trust.

Gross income - see Income.

Guardian - a person appointed by the court to care for another person as specified in the court.

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HCBS (Home and Community-Based Services) - home care services which are Medicaid reimbursable pursuant to a federal waiver.

HHS (Health and Human Services) - the United States Department of Health and Human Services.

HUD (Housing and Urban Development) - a U.S. government department.

HUD escrow account - an account established by HUD under the Family Self-Sufficiency (FSS) Program whereby participating families will have a portion of any rent increase which resulted from increased earnings credited to the account.

Health insurance plan - an individual or group insurance policy or contract or a medical or hospital service agreement or other health care delivery system for the purpose of paying for or reimbursing the cost of hospital and medical care.

Hit - a discrepancy found between WES data and the interface with records of other agencies such as IRS, wages and UIB, RSDI, SSI, State Retirement, Worker's Compensation, etc.

Home - for the purpose of eligibility for Long Term Care Medicaid and Medicare Savings programs, an individual's home is property in which he or she has an ownership interest and that serves as his or her principal place of residence, it can include any of the following:

the shelter in which he or she lives

the land on which the shelter is located

related buildings on such land

Homeless - the condition or lack of a permanent dwelling or lack of a fixed or home address.

Household furnishings - furniture, electric appliances, clothing and personal items owned by the household .

Household Unit - Persons included on a Medicaid application.

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ICF/ ID - Intermediate Care Facility for the Intellectually Disabled .

IHC - Inpatient Hospital Care.

IIM - Individual Indian Monies.

INA (Immigration and Naturalization Act) - P.L. 99-603.

IRA (Individual Retirement Account) - a pension or plan that permits individuals to set aside savings that are tax free until retirement.

IRS (Internal Revenue Service) - the U.S. government tax collection agency.

Immigrant - a person residing in, and who is not a citizen of the U.S.

Impairment-related work expenses - an amount disregarded for items or services which are directly related to enabling a person with a disability to work and which are necessarily incurred by the individual because of a physical or mental impairment.

Incapacitated - a temporary or permanent condition of blindness, physical disability or mental incompetence determined by WDH.

Income - money received from any source but not any item specified in policy as a resource.

A. Contract income - earnings paid through an agreement with another; considered self-employment if the individual is paying her/his own taxes;

B. Countable income - the amount of income used to determine eligibility.

C. Earned income - payment received in cash or in-kind for wages, salary, tips, commissions as an employee, or net-profit from activities in which the individual is engaged as self-employed.

D. Exempt income - money set aside or free from program policy or limits.

E. Fluctuating income - monthly income that varies in frequency of receipt or amount each month due to working overtime, hourly pay with varying hours, receipt of tips or commissions, changes of hours or pay rate or decrease or increase in hours of work due to vacations, sick leave or seasonal employment.

F. Gross income - the total money the person receives prior to any deductions such as Social Security, withholding tax, garnishments etc.

G. In-kind income - the receipt of goods or services instead of money.

H. Irregular income - income the applicant/recipient cannot reasonably expect to receive.

I. Net income or profit - the gross receipts from self-employment less the current business expenses and/or the allowable income deductions.

J. Nonexempt income - all money received to which the program policy limits are applied.

K. Ongoing income - money received on a regular basis, no less frequently than monthly, and is expected to continue.

L. Self-employment income - earning one's own living directly from one's own profession or business rather than earning a salary or commission from another.

M. Stable income - income received in a set/fixed amount from the same source(s) on a regular basis and there is no additional income that fluctuates.

N. Unearned income - all money received that is not earned by providing goods and services or defined as a resource.

Income producing property - property essential to the production of goods and services, including stock (merchandise), inventory, tools, equipment, trucks, cars, earth moving equipment, etc. This property is used in a trade, business, or other income producing activity.

Incomplete report - any information furnished in writing, in person or by phone which concerns a change in circumstances but is insufficient to verify and/or act upon the change.

Indian land - real property owned jointly by the tribe or where the sale can be made only with the permission of other owners, the tribe or the BIA.

Individual's Immediate Family “Individual” means the applicant or client. - The individual's immediate family includes his or her:

• parents, including adoptive parents;

• minor or adult children, including adoptive and stepchildren;

• siblings (brothers and sisters), including adoptive and stepsiblings.

“Immediate family” also includes the spouse of the above relatives. If the relative's relationship to the recipient is by marriage only, the marriage must be in effect in order for the burial space exclusion to continue to apply. For example, a burial space held for a sister-in-law is no longer excludable if she and the recipient's brother divorce.

Ineligible - not entitled to receive a benefit due to failure to meet one or more of the specified conditions required by the program.

Initial eligibility determination - the act of evaluating each eligibility factor for each person applying for benefits, and finding the case eligible or ineligible during the initial processing period.

Initial month - see Month.

Institution - an establishment that furnishes (in single or multiple facilities) food, shelter and/or some treatment or services to four or more persons unrelated to the proprietor.

Institutionalized individual - an individual who meets one of the following criteria:

A. A patient of a nursing facility.

B. A patient in a hospital receiving swing bed services.

C. A patient receiving home- or community-based services furnished under a waiver.

Institutionalized spouse - a spouse who lives in a swing bed, nursing home facility or receives HCBS or Hospice services.

Insurance settlements - the money received by a person(s) from a company for damage of property or person.

Irrevocable - incapable of being canceled, rescinded, broken or changed by the action of either party.

Irrevocable income trust - a document appointing a person, known as a Trustee, to manage the grantor’s income placed in the trust.

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Joint tenancy/Joint tenancy with survivorship - A tenancy with two or more co-owners who take identical interests simultaneously by the same instrument and with the same right of possession. A joint tenancy differs from a tenancy in common because each joint tenant has a right of survivorship to the other’s share (in some states, this right must be clearly expressed in the conveyance – otherwise, the tenancy will be presumed to be a tenancy in common.

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Knowledgeable source -

A. A person who has a considerable degree of familiarity of a subject gained through experience with or association with the individual or subject.

B. For evaluation of a resource, a person who is professionally aware of the value of the property in the community.

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LIEAP (Low Income Energy Assistance Program) - a 100% federally funded program that exists to partially meet the cost of home heating energy.

Late reporting - information not furnished when the change becomes known to the client or verifications which are not furnished within the allowable time frames.

Law enforcement - persons or agencies that require compliance with the principles and regulations established in a community under the authority of state and/or federal legislation and enforced by judicial decision.

Legal barrier - see Barrier to sale.

Legal encumbrance - a lien or claim on a resource which is recognized by law.

Legal obligation - an obligation, such as a court order, that would be upheld by a judge in a court of law, i.e., a divorce decree, an order issued through an administrative law judge, or a legally enforceable separation agreement.

Legal residents - l awfully residing in the United States.

Life estate - the rights of ownership belonging to an individual and existing until the individual's death but actual title or deed to the property belongs to another individual.

Life insurance - a contract on which the owner pays premiums during his lifetime and:

A. The company pays at least the face amount of the policy to the beneficiary upon the death of the insured.

B. The payment may include a loan or cash surrender value.

C. The payment may include accumulated dividends.

Likely to remain - a determination made by a public health nurse and/or case manager that an institutionalized person is expected to remain in an institution for 30 consecutive days or longer.

Liquid resource - see Resources.

Loan - a debt the borrower has an obligation to repay (See Bona fide).

Lump sum - a payment of earned/unearned money, i.e., payment of retroactive benefits such as, but not limited to, RSDI, lottery winnings, UIB, cash inheritances or workers compensation awards. It is the total amount received minus legal fees required to make the money available and minus the amount designated by the payer or source for medical expenses.

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Magi (Modified Adjusted Gross Income) - The figure used to determine eligibility for lower costs in the Marketplace and for Medicaid and CHIP. Generally, modified adjusted gross income is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have.

Mail-In Application - A mail-in application is defined as any application that is mailed in by the individual, representative, or another agency.

Majority Owners - owners whose fractional interests of real property total 50% or more.

Mandatory - refers to a person(s) who is required to meet specified provisions within the law, rules and/or policy.

Marriage or married couple - a contractual relationship recognized by the State of Wyoming with a document, certificate or license or when SSA decides either of the couple is entitled to a Social Security benefit as a spouse.

Mass change - the act of affecting appropriate cases by issuing a new or revised policy caused by a change in state or federal law.

Medicaid - a federal and state funded program that provides health coverage for selected categories of individuals with low income and limited resources established under Title XIX of the Social Security Act.

Medicaid Eligibility Quality Control (MEQC) - a federally mandated process to monitor the administration of eligibility for State Medicaid programs.

Medical professional - a licensed physician, a psychologist or master's level mental health worker. This includes a physician's assistant, public health nurse, registered nurse, or licensed practical nurse.

Medicare Cost Sharing Groups - t his includes the Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary Medicaid programs.

Medicare Savings Programs (MSP) - special Medicaid programs for individuals receiving Medicare who have limited income and resources.

A. QMB (Qualified Medicare Beneficiary) - covered under Section 1902(a)(10)(E)(iii) of the Social Security Act. Medicaid pays for Medicare Part A and Part B premiums, deductibles and co-payments.

B. QDWI (Qualified Disabled and Working Individuals ) - covered under Section 1902(a)(10)(E)(ii) of the Social Security Act. Medicaid pays the Medicare Part A premium.

C. SLMB (Specified Low-Income Medicare Beneficiary) – covered under Section 1902(a)(10)(E)(iii) of the Social Security Act. Medicaid pays the Medicare Part B premium.

D. QI (Qualified Individual) - covered under Section 1902(a)(10)(E)(iv) of the Social Security Act. Medicaid pays the Medicare Part B premium.

Medicare Set-Aside (MSA) Account - m oney from a Workers’ Compensation or personal injury settlement that is set-aside for future medical care must be put into a special account called a Medicare Set-Aside (MSA) Account. When the money in the MSA Account is exhausted, Medicare will begin paying bills for the injury, but only if the money is spent properly. The Center for Medicare and Medicaid Services (CMS) reviews these account every year.

Mental health professional - a licensed psychologist or master's level mental health worker employed by a public or private human services organization or in private practice.

Minor - a person under age 18 who does not meet emancipation criteria in Wyoming laws.

Minor parent - a person who is under the legal age of 18 who is not emancipated and is either the parent of a dependent child living with him/her or is pregnant.

Minority Owners - owners whose fractional interests of real property is less than 50%.

Month -

A. Benefit month - the calendar month for which eligibility will be authorized and benefits issued.

B. Current month - the month in which eligibility is determined.

C. Initial month - the first month for which the clien t is authorized following any break in aid.

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Net income - see Income.

Net profit - the gross receipts, less the current business expenses (See Business expenses and income).

Non-custodial parent - any parent who is not providing care and control of the child(ren) or who cannot be counted on to function in the planning for the physical care, guidance and maintenance of the child(ren).

Nonexempt - (countable) a category of income or resources to be used in budgeting or to which the program policy and limits are to be applied.

Notice of adverse action - a written statement which informs the applicant/recipient of the intended action to be taken, a change in their benefits, or closure of their case. This statement should include the reason and specific regulation(s) supporting the action, the date the action will occur and a statement of the person's right to request a hearing.

A. Adequate notice - a notice of action informing the applicant or client of a decrease or closure in benefits to be received by the household no later than the date the benefits would have been received.

B. Fifteen-day notice period - the fifteen days immediately following the day the notice is mailed per the date on the WES notice.

C. Timely notice - a notice of action mailed at least fifteen days before the date the action would become effective.

Numident - the tape of matched and unmatched Social Security numbers transmitted from the eligibility computer system and run against SSA files.

Nursing Home - a nursing home is more of a permanent residence for people in need of 24/7 care, while a skilled nursing facility is a temporary residence for patiets undergoing medically necessary rehabilitation treatment.

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OBRA 93 - the Omnibus Budget Reconciliation Act of 1993, Pub. L. No. 101-66.

Ongoing eligibility determination - the act of evaluating each open case and finding the case eligible or ineligible based on the reported change in circumstances.

Ongoing income - see Income.

Open case - a client or household authorized in WES for medical benefits.

Out stationing facility - facility designated by WDH to give medical information and/or accept medical applications.

Overpayment/Over-issuance - benefits issued to a client for the benefit month which exceeds the amount for which the client was eligible.

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POSSE (Parental Obligation System for Support Enforcement) - the child support enforcement computer system.

Parent - an individual who has established a parent-child relationship under W.S. 14-2-501.

Parental support - see Support.

PASS account - an account set up by an SSI recipient for the specific purpose of fulfillment of a Plan for Achieving Self-Support under Title XVI of the Social Security Act.

Paternity - a legal relationship existing between a child and his natural, legal or adoptive father per W.S. 14-2-501 b .

Patient contribution - the monthly amount the Aged, Blind and Disabled individual must pay to the cost of care/services.

Payee - the person in whose name the benefit is issued.

Payment - the act of giving a check or warrant to the grantee or the legal representative.

Payment Error Rate Measurement (PERM) - A federally mandated process to measure improper payments in Medicaid and State Children’s' Health Insurance programs. In addition to reviews of claims data, PERM contains an eligibility portion to measure payment errors as a result of improper eligibility determination and eligibility processing.

Periodic review - a review conducted, as designated in policy, to determine continued eligibility. Documentation should be entered in the case file to acknowledge the review occurred.

Perjury - a willful false statement of a material fact, swearing to what is untrue or omitting to answer all questions under oath.

Personal injury insurance - protection purchased from a company for the payment of cash upon occurrence of an injury or accident and is not for repair, replacement or medical expenses.

Personal needs - a monthly amount of income a Medicaid individual in a nursing home retains to pay for required personal items.

Personal property - all things owned or possessed excluding land and building affixed thereto.

PICKLE Amendment - a federal law requiring Medicaid coverage for an individual who lost SSI for any reason and would remain eligible for SSI if the RSDI cost of living adjustment (COLA) was deducted from her/his income.

Power of Attorney (POA) - a written document a person signs appointing another person to legally act on behalf of or perform duties as if s/he was the person taking the action.

Presumptive eligibility - approval from a qualified provider or qualified hospital for temporary medical services for certain Medicaid programs until an application can be approved or denied by the WDH Customer Service Center.

Primary beneficiary - a person who has worked the specified number of quarters in covered employment and is eligible for retirement or disability benefits from SSA in his/her own right.

Primary evidence - a document or record of an official government agency or public institution accepted in a judicial proceeding as establishing the truth.

Promissory Note - a promissory note is a written, unconditional agreement whereby one party promises to pay a specified sum of money at a specified time (or on demand) to another party. It may be given in return for goods, money loaned, or services rendered.

Property - both real and personal resources owned by the family unit.

Property Agreement - a pledge of security of particular property for the payment of a debt or the performance of some other obligation within a specified period. Property agreements on real estates generally are referred to as mortgages but also may be called real estate or land contract, contracts for deed, deeds or trust.

Prorate - divide or distribute proportionally:

A. Based on days of eligibility for initial months of eligibility.

B. To determine months of ineligibility because of receipt of a lump sum.

C. To average income over intended period of use for self-employment or contractual income.

Prospective budgeting - using the best estimate of the income and circumstances that will exist in the benefit month to determine eligibility and to compute the benefit.

Prospective eligibility - the method of testing income, expenses and circumstances for a future benefit month against specified conditions or factors when eligibility requirements are met.

Public assistance - any program where income and/or resources are tested to determine eligibility, i.e., POWER, SSI, Food Stamps, Child Care and medical assistance, etc.

Public institution - a governmental establishment, or an establishment over which a governmental unit exercises administrative control, that furnishes (in single or multiple facilities) food, shelter and some treatment or services to persons unrelated to the proprietor. The following are public institutions in Wyoming: State Hospital, Wyoming Life Resource Center , State Penitentiary, Women's Center, Honor Farm, Girls' School, Boys' School, and city/county jail facilities.

Pursuit - the act of seeking, obtaining or accomplishing the payment of child support through commonly accepted child support enforcement procedures.

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Q DWI ( Qualified Disabled and Working Individuals ) - see Medicare Savings programs.

QMB ( Qualified Medicare Beneficiary) - see Medicare Savings programs .

Qualified immigrant - A qualified immigrant means an immigrant who is in one of the following categories as determined by the United Stated Citizenship & Immigration Services (USCIS):

A. Lawfully admitted for permanent residence (LPR) in the United States (holders of green cards). This category includes "American immigrants" as defined under section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988;

B. Granted asylum under section 208 of the Immigration and Nationality Act (INA);

C. Refugee admitted to the United States under section 207 of the INA (the Trafficking Victims Protection Act of 2002 (Public Law 106-386) requires victims of a severe form of trafficking to be treated as refugees for food stamp purposes);

D. A refugee, asylee, one whose deportation is withheld for up to seven years upon entry into the U.S. or a parolee for up to one year after entry into the U.S.

E. Paroled into the United States under section 212(d)(5) of the INA for at least one year;

F. Deportation is being withheld under section 243(h) of the INA as in effect before 4/1/97, or removal is withheld under section 214(b)(3) of the INA;

G. Granted conditional entry under section 203(a)(7) of the INA as in effect before 4/1/80;

H. Cuban or Haitian entrant under section 501(e) of the Refugee Education Assistance Act of 1980; or

I. Under certain circumstances, a battered spouse, battered child or parent or child of a battered person with a petition pending under 204(a)(1)(A) or (B) or 244(a)(3) of the INA.

J. U.S. military connection (veteran, active duty, spouse or unmarried dependent child);

K. Lawfully in the U.S. on 8/22/96 and age 65 or older;

L . Canadian born Indians under 289 of the INA;

M. Afghan or Iraqi Special Immigrants status under section 101 (a)(27) of the Immigration and Nationality Act (INA) shall be available to refugees admitted under section 207 of such Act.

N. Compacts of Free Association (COFA) - Citizens from the Federal States of Micronesia, the Republic of the Marshall Islands and Palau who lawfully reside in the United States.

Qualified Individual (QI) - see Medicare Savings Programs.

Qualified Long-Term Care Partnership Policy - A policy that meets all of the following requirements:

A. The policy covers a beneficiary who was a Wyoming resident or resident of another partnership state when coverage first became effective under the policy;

B. Is a qualified long-term care insurance policy as defined in Section 7702B(b) of the Internal Revenue code of 1986 issued not earlier than the effective date of the State Plan amendment;

C. The Department of insurance has certified that the policy meets the model regulations and requirements of the national Association of Insurance Commissioners model specified in paragraph (5) of the title VI, section 6021 of the federal Deficit Reduction Act of 2005

D. The policy meets the inflation protection federal requirements set forth in section 1917(b)91)(C)(iii)(IV) of the Social Security Act.

E. The policy was issued or amended no earlier than July 1, 2009

Qualifying quarters - quarters of coverage under Title II of the Social Security Act, including quarters worked by the immigrant, a parent while the immigrant was under 18 and quarters worked by a spouse while married to the immigrant, and has not received government benefits.

Quality Assurance (QA) - Evaluating overall performance on a regular basis to provide confidence that the relevant quality measures and standards are satisfied.

Quality Control (QC) - Monitoring specific results to determine if they comply with relevant quality standards and identifying ways to eliminate causes of unsatisfactory performance.

Quarter - three calendar months - January through March, April through June, July through September and October through December.

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RSDI (Retirement, Survivors and Disability Insurance) - insurance through the Social Security Administration under Title II of the Social Security Act.

Real property - land and buildings or immovable objects permanently attached thereto; land, and generally whatever is erected, growing upon or affixed to the land.

Reapplication - the completion of an application in writing requesting assistance after being ineligible for benefits for more than one calendar month or, for FS, following a break in participation.

Reasonable appraisal - a value given by a knowledgeable source close in amount to the similar property values in the community or is logical using prudent person judgment.

Reasonably expected - the condition of being in agreement with the belief an event will occur.

Recipient - a person who is eligible for and receiving benefits in her/his own behalf or in behalf of others.

Recover - to collect a payment issued for which the person(s) was not eligible.

Redetermination - to re-verify each factor of eligibility, establish a new best estimate of income, when applicable, make a decision of eligibility and benefit amount based on the verified information and performance standards and enter documentation in the case record when a change in circumstances is reported.

Reinstate - to restore the c lient to eligible status when the client is determined eligible based on new information, or an administrative hearing has been requested timely .

Relative -

A. An individual who is through marriage, blood relationship, or court decree, the grandparent, great-grandparent, sibling, aunt or uncle of a child;

B. Any blood relative, including those of half-blood, first cousins, nephews and nieces and persons of preceding generations denoted by prefixes of grand, great or great-great are included in this definition;

C. Stepmother, stepfather, stepbrother and stepsister;

D. Adoptive or natural parents and their adopted or natural children;

E. Siblings, including those related through adoption; and

F. Spouses of any person mentioned above are considered relatives even though the marriage may be terminated by death or divorce.

Rental expenses - costs necessary for the production or collection of rental income, including interest on debts, state and local taxes on real and personal property, general sales taxes, expenses of managing or maintaining the property interest and escrow portions of a mortgage payment, real estate insurance, repairs, lawn care, snow removal and advertising for a tenant.

Resident - a person who lives or dwells in Wyoming for a continued period of time with the intent to reside permanently in the state.

Resource - Any physical property, financial accounts, or other liquid possessions.

Restitution - full payment of assistance paid in error.

Room and/or board income - money received from providing rooms and meals, if a boarder.

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SAVE (Systematic Alien Verification for Entitlement) - the USCIS program whereby state agencies may verify the validity of documents provided by immigrants applying for public assistance benefits by obtaining information from a central data file.

SDX (State Data Exchange System) - used to notify the State of the people eligible for SSI.

SHP - State Hospital Placement.

SLMB (Specified Low-Income Medicare Beneficiary) - see Medicare Savings Programs.

SS 5 - an application for a Social Security number and card.

SSA (Social Security Administration) - a division of the U.S. Department of Health and Human Services that administers federal social security programs.

SSI (Supplemental Security Income) - the program funded under Title XVI of the Social Security Act.

SSN (Social Security number) - the account number assigned to all persons who apply and will be used to accumulate work history and contributions for payment of Social Security benefits.

SVES (State Verification and Exchange System) - an automated system which allows rapid access to SSA and SSI information.

Sanction - for Family Care, a restrictive measure or penalty imposed against a recipient for failure to cooperate with the child support authority, or with WDH's third party liability unit.

School - an elementary school, a secondary school or the equivalent to a secondary school or high school.

Secondary evidence - a document or record of a declaration of fact by individuals or entities that have no responsibility to establish the fact and is inferior to primary or best evidence.

Self-employed - when an individual earns her/his living directly from her/his own profession or business AND pays her/his own taxes rather than earning a salary or commission from another.

Sibling - brother, sister, stepbrother, stepsister, half brother, half sister and adopted brother or sister.

1619 Individual - Section 1619 of the Social Security Act provides benefits for disabled or blind individuals who are SSI eligible except for earned income.

Special needs - a child who is less than 18 years old who is developmentally disabled or has a mental or physical incapacity which limits her/his ability to care for herself/himself.

Sponsor - any person or any public or private organization that has executed an "affidavit of support" (USCIS Form I-134) or similar legally binding agreement to support an immigrant as a condition of the immigrant's admission for permanent residence in the U.S. An immigrant may have more than one sponsor.

Sponsored immigrant - an immigrant lawfully admitted for permanent residence into the U.S. and for whom an affidavit of support has been executed.

Spousal maintenance allowance - the amount deducted from the patient contribution for the needs of the community spouse established each January 1 by CMS.

Spousal resource allowance - an amount set by CMS each January 1 as the maximum resources necessary for a community spouse to maintain himself/herself in the community.

Spousal support - see Support.

Stable income - see Income.

Statement - a formal declaration of the circumstance(s) as requested by the agency.

Statute of limitations - the time allowed in the Wyoming statutes in which court action may be initiated and there is no limitation for debts owed to the state of Wyoming.

Stepparent - the spouse of a natural or adoptive parent, who is not a natural or adoptive parent.

Strike - any concerted slowdown, interruption of operations by employees or any stoppage of work by employees, including a stoppage by reason of the expiration of a collective-bargaining agreement.

Support -

A. Alimony/Spousal support - a court or voluntary payment made to an individual by his/her spouse/former spouse;

B. Child support - a court ordered or voluntary payment made by a non-custodial parent for his/her child(ren) to assist with day-to-day maintenance;

C. Military allotment - the military payment allocated as support for a service person's dependents.

D. Parental support - providing to one's child the necessities such as food, clothing, housing, health and medical needs and is usually meant to be provided by expenditure of money or by in-kind unearned income.

Swing bed - a bed in a rural hospital with less than 50 beds that can be used for skilled or intermediate nursing home care and licensed and certified by WDH.

Sworn statement - declaration under penalty of perjury the written information is true and correct.

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TPL (Third Party Liability) - an individual, entity or program that is or may be liable to pay all or part of the medical costs of injury, disease or disability of a client.

TPQY (Third Party Query) - an automated system which allows rapid access to SSA and SSI information.

Temporary absence - see Absence.

Tenancy in common - A tenancy by two or more persons, in equal or unequal undivided shares, each person having an equal right to possess the whole property but no right of survivorship.

Terminate - to close a case and/or an individual from a program; to end the certification period before the scheduled time of expiration.

Timely reporting - when information is provided either in writing, in person or by telephone within ten days of the day the client becomes aware of the change in circumstances.

Trafficking -

A. For victims, a commercial sex act is induced by force, fraud or coercion or in which the person induced to perform such an act has not attained 18 years of age and the recruitment, harboring, transportation, provision or obtaining of a person for labor or services through the use of force, fraud or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage or slavery;

B. For fraud, illegally trading, buying or selling Food Stamp benefits.

Trust - a property interest held by one person for the benefit of another.

Trustee - any person(s) appointed by the instrument creating the trust, or any person appointed by the court to administer the trust. (AKA grantee)

A. Trustor - the person who sets aside resources by placing them in a trust. Also known as donor, grantor or settler; and

B. Beneficiary - the person(s) who benefits from the trust during the life of the trustor and/or who benefits upon the death of the trustor. Any person(s) appointed by the instrument creating the trust, or any person appointed by the court to administer the trust (aka grantee).

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UIB - Unemployment Insurance Benefit.

U.S. (United States) - defined in a geographical sense as the continental United States, Alaska, Hawaii, Puerto Rico, Guam, U.S. Virgin Islands and Northern Mariana Islands.

USCIS (United States Citizenship and Immigration Services) - the U.S. agency responsible for admitting and assigning residence status to people entering the U.S. from other countries.

Unavailable - income and resources

A. Money from a lump sum incapable of being used for day-to-day needs of the household because it was spent or lost as the result of a disaster which was beyond the family's control; or

B. A jointly owned resource the second party refuses to sell and each owner does not have the legal right to sell his/her share; or

C. The resource is inaccessible because a legal barrier or restriction exists; or

D. Income inaccessible to the client because s/he does not have a legal interest in or is tied up in divorce or other legal action.

Uncompensated Value - see Value.

Undocumented Non-Citizen - a foreign national who:

A. Entered the U.S. without appropriate documentation; or

B. After entering legally as a documented non-citizen, remains in the U.S. after documents expired or were revoked.

Undue hardship - when an individual would be forced to go without life sustaining services altogether or as otherwise determined on the basis of criteria.

Unearned Income - see Income.

Unpaid principal - the balance to be paid on an agreement to buy or sell.

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VA - the Veterans Administration of the U.S.

VISTA - Volunteers in Service to America.

Value - the monetary worth of a good or service.

A. Cash surrender value (CSV) - the amount the insurer will pay upon cancellation of the policy before death of the insured or before maturity of the policy.

B. Cash value -

1. For resources, the amount that would be paid if the resource were sold or converted to cash;

2. For income, the amount of the income or the value assigned to the service rendered for in-kind income.

C. Current market value (CMV) - the amount for which the property can be expected to sell for on the open market in the community at the time of determination or at the time of transfer or sale.

D. Equity value - the CMV or FMV less any legal debts or encumbrances. For vehicles the equity value is FMV or trade-in value less encumbrances.

E. Face value - the basic death benefit of an insurance policy exclusive of dividend additions or amounts payable due to accidental death or other special provisions.

F. Fair market value (FMV) - the amount of money the sale of property would currently (or at the time of transfer) bring on the open market in the community where the property is located.

G. Trade-in value - for vehicles such as automobiles, trucks, vans and motorcycles, it is the trade-in value according to the Edmund's Automobile Valuation internet site or the lower of two reasonable appraisals of the amount that would be given if the vehicle was exchanged for another or turned in.

H. Uncompensated value - the current market value less the gross sale price.

Vendor - the person or business that provides goods or services to the recipient or on behalf of the recipient.

Vendor payment - the amount paid o n behalf of a household which the household cannot convert to cash to meet its needs.

Verification - the act of confirming or proving a fact to be true by obtaining documentation.

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WDH - the Wyoming Department of Health.

WES - Wyoming Eligibility System.

WHIPP - Wyoming Health Insurance Premium Payment program.

WIA (Workforce Investment Act) - the federal training act, which replaced the JTPA (Job Training Partnership Act) programs.

WIC (Women, Infants and Children) - supplemental nutritional program administered by the Wyoming Department of Health.

WOLFS - Wyoming On-Line Financial System.

Widow/Widowers - Individual between age of 50 and 64 who was receiving SSI benefits and lost SSI due to receipt of Widow Widowers benefits.

Wyoming Life Resource Center - Formerly Wyoming State Training School.

This section will describe the factors requiring verification, how to verify eligibility factors, how to properly document eligibility factors, and which evidence may be used in determining eligibility.

This section will describe the eligibility factors requiring verification and discuss the methods that may be used to verify these eligibility factors.

Current Policy Effective Date: July 1, 2023

Date Last Reviewed: July 31, 2023

Previous Policy: April 1, 2023

POL M301A: FACTORS REQUIRING VERIFICATION

1. Citizenship And Identity Must Be Verified Within 90 Days

Medicaid applicants who declare U.S. Citizenship and identity, have 90 days to provide verification from the date of approval. Refer to Medicaid Table 5 for evidence of citizenship and identity except for the following programs that do not have this verification requirement:

Emergency Services. Basic Foster Care. Institutional Foster Care.

2. Citizenship And Identity Verification Not Required

Verification of citizenship and identity has already been documented by the Social Security Administration; for that reason, verification is not required for the following Individuals:

Entitled to Supplemental Security Income (SSI). Entitled to Social Security Disability. Entitled to or enrolled in Medicare.

Verification of citizenship and identity is not required for a newborn of a Medicaid eligible mother.

Verification of citizenship and identity is not required when documentation has already been provided for a previous application or can be verified by reliable information available to the Department.

3. Date Of Birth Must Be Verified

Any electronic source or document that verifies citizenship and lists the applicant's date of birth can be used to verify date of birth. Refer to Medicaid Table 5 for evidence of citizenship.

4. Social Security Number Must Be Verified

SSN can be verified via the following electronic sources:

SDX

SOLQ-I

SVES

A Social Security card can be used as hard copy verification of SSN.

5. Eligibility Must Not Be Delayed

Eligibility determination must not be delayed while verification for other programs is pending.

6. Age Must Be Verified

Age must be verified using primary or second level documents for the Aged, Blind or Disabled Programs. Refer to Medicaid Table 5B .

7. Income Must Be Verified

Income must be verified using primary or secondary evidence sources. Refer to Medicaid Table 5B .

A report of zero income must be verified through electronic sources for any household member age 14 and over.

Verification of income is not required for the Medicare Savings Programs when an application is received from the Social Security Administration (SSA), referred to as the MIPPA file. Post eligibility electronic verification is used when there is conflicting or incomplete information provided by SSA.

8. Income Deductions Must Be Verified

Tax deductible adjustments to income for MAGI programs must be verified at application and renewal or when the deduction is added to the case.

Client can request the deduction not be included in the calculation if they cannot provide verification.

Deductions that do not make a difference in eligibility do not need to be entered into WES or verified.

9. Resources Must Be Verified

Resources must be verified for the Aged, Blind or Disabled (except for the Employed Individuals with Disabilities (EID) and Medicare Savings Programs, using primary or secondary evidence sources. Refer to Medicaid Table 5B .

Verification of resources is not required for the Medicare Savings Programs when a MIPPA application is received from the Social Security Administration (SSA). Post eligibility electronic verification is used when there is conflicting or incomplete information provided by SSA.

Defining Requirement: 42 CFR 435.940

42 CFR 435.945

42 CFR 435.948

42 CFR 435.952

42 CFR 435.953

42 CFR 435.955

42 CFR 435.960

1. Verification is defined as the act of proving a fact to be true by obtaining documentation.

2. Clients who were issued on Medicaid prior to 01/01/2014 can have DOB, SSN, Citizenship and Identity changed to Collateral Contact in WES as these items were verified by DFS on the original application.

Verifying Eligibility Factors

1. Refer to Section M301B for information on how to verify eligibility factors.

Current Policy Effective Date: July 1, 2023

Date Last Reviewed: June 28, 2023

Previous Policy: January 1, 2014

POL M301B: VERIFYING ELIGIBILITY FACTORS

1. Vital Statistics Services Portal Can Be Used To Verify Citizenship

Verification of citizenship can be obtained by using the Vital Statistics Services Portal . Refer to Medicaid Table 5 for acceptable verification of citizenship.

2. Revenue Information System (RIS) Can Be Used To Verify Citizenship and Identity

Verification of citizenship and identity can be obtained by using the Revenue Information System (RIS) through the Mainframe at the TPX menu. Refer to Medicaid Table 5 for acceptable verification of citizenship and identity.

3. Evidence Must Be Collected to Establish Eligibility

Evidence must be collected to meet documentation and verification requirements for all eligibility factors. Refer to Medicaid Table 5 , Table 5A , Table 5B and Table 6 for proper documentation.

4. Prior Cases May Be Used To Verify Some Eligibility Factors

Documentation from prior cases may be used for factors not subject to change, such as SSN, date of birth, citizenship, or identity.

5. System Interfaces And Electronic Resources May Be Used

Verification of eligibility factors may be obtained by using:

SVES SOLQ-I BENDEX RIS SDX SAVE Workforce Services VSS AVS

6. Additional Documentation May Be Required

Applicants/clients may need to provide additional documentation necessary to verify eligibility factors.

7. Assistance Obtaining Documentation Must Be Provided

Assistance must be provided to the applicant/client, upon request, in obtaining documentation.

Defining Requirement: 42 CFR 435.940

42 CFR 435.945

42 CFR 435.948

42 CFR 435.952

42 CFR 435.953

42 CFR 435.955

42 CFR 435.960

Citizenship and Identity Requirement: Social Security Act § 1903

1. Verification is defined as the act of proving a fact to be true by viewing the content of the evidence.

Current Policy Effective Date: January 1, 2014

Date Last Reviewed: October 22, 2015

Previous Policy: October 1, 2005

POL M302: DOCUMENTING ELIGIBILITY FACTORS

1. Documentation Required For Family and Children’s Programs

Family and Children’s programs require the following documentation be included in a case file:

Signed application, if client applied via paper application. Verification of citizenship, identity, date of birth and SSN. Detailed case notes in WES. Verification of income. Verification of other factors upon request.

2. Documentation Required For Aged, Blind, Or Disabled And Medicare Savings Programs

Aged, Blind, Or Disabled programs require the following documentation be included in a case file:

Signed application, if client applied via paper application. Verification of citizenship and identity. Medical necessity forms, if required. Detailed case notes in WES. Verification of all income and resources.

Defining Requirement: 42 CFR 435.913

Using Wyoming Birth Cert. Application Tab

1. Access Wyoming Birth Cert Application tab located within ECOM. Refer to Section M604 for instructions on accessing and using Birth Cert Application.

Requesting Birth Certificates from Vital Records

1. Print letter of request on official DFS Field Office letterhead.

2. Specify one person per letter.

3. Specify individual’s:

3A. Full name at birth.

3B. Mother’s maiden name.

3C. Father’s name.

3D. Date of birth.

3E. Place of birth.

4. Include a self-addressed, stamped envelope.

5. Address to:

Department of Health, Vital Record

Hathaway Building, First Floor

Cheyenne, WY 82002

Obtaining Immigration Status Documentation

1. Refer to Section M604 for information on the SAVE process and contacting US Citizenship and Immigration Services (USCIS).

This section describes the application process for Medicaid programs. It covers completing an application, assistance with completing applications, processing applications, Medicaid cards, outstationing, client rights, worker responsibilities, narratives, paper files, confidentiality, and safeguarding and releasing information.

Current Policy Effective Date: September 1, 2019

Date Last Reviewed: August 26, 2019

Previous Policy: September 1, 2018

POL M401: APPLYING FOR BENEFITS

1. Applicants Must Complete An Application

Below is the Medicaid Application:

Health Coverage Application , use for all Medicaid programs.

Health Coverage Application, (Spanish version) , use for all Medicaid programs.

2. Medicare Part D Low-Income Subsidy (LIS) Data Exchange

The Medicare Part D, Low-Income (LIS) Data Exchange is transmitted to the states from the Social Security Administration. The Medicaid Eligibility Unit will distribute necessary information on a spreadsheet referred to as the MIPPA file to the Wyoming Department of Health Customer Service Center to process as an application for the Medicare Savings Programs.

3. Methods To Obtain A Paper Application

Applicants may pick up an application at any Department of Family Services field office; print one from the Wyoming Department of Health web site or contact the Wyoming Department of Health (WDH) Customer Service Center at 855-294-2127 to request one be mailed or faxed.

Paper applications can be mailed or delivered to:

WDH Customer Service Center

3001 E Pershing Blvd., Suite 125

Cheyenne, WY 82001

WDH Long Term Care unit

122 W 25th St, West 4th Floor

Cheyenne, WY 82002

Faxed to:

The WDH Customer Service Center at 855-329-5205 The WDH Long Term Care Unit at 307-777-8399

Emailed to:

wesapplications@wyo.gov

4. Other Ways To Apply

Individuals can apply:

Over the phone through the WDH Customer Service Center at 855-294-2127 Over the phone through the WDH Long Term Care Unit at 855-203-2936, when applying for Long Term Care Services Online at www.wesystem.wyo.gov

5. Not Required To Complete Application

The following applicants are not required to complete an application:

Applicant takes the appropriate action within 60 days from denial and 90 days from closure. Individuals eligible for Supplemental Security Income (SSI). Newborns of a Medicaid eligible mother.

Defining Requirement: 42 CFR 435.905 – 912

LIS or MIPPA File

Upon receipt of a MIPPA file, the WDH LTC Unit Consultant copies and pastes the information transmitted from the Social Security Administration into an Excel spreadsheet, formats and sends to the Customer Service center. Customer Service Center (CSC) processes the MIPPA file and registers the application in WES. CSC enters the Social Security income and uses collateral contact for verification. If there is a spouse, the Social Security income of the couple is combined. Enter the total Social Security income under the applicant and $0.00 for the spouse. This will trigger the BENDEX interface to obtain individual income for each spouse. No other verifications are required unless there is conflicting information. Client's must be periodically reviewed every 12 months under the Medicare Savings Program. Refer to Section M1403 for information on reviewing eligibility.

Current Policy Effective Date: October 1, 2006

Date Last Reviewed: May 7, 2007

Previous Policy:

POL M402: Assisting With Application Process

1. Applicants May Request Assistance in Completing Applications

2. Applications Are Available in English and Spanish

3. Interpreter Services Must Be Provided

Interpreters must be available to non-English speaking applicants.

Interpreters provide assistance with:

Completing applications. Scheduling interviews. Translating during interviews

Defining Requirement: 42 CFR 435.908

Timely Determination: 42 CFR 435.912

Timely and Adequate Notice: 42 CFR 435.913

Current Policy Effective Date: June 1, 2024

Date Last Reviewed: June 19, 2024

Previous Policy: December 1, 2022

POL M403: PROCESSING APPLICATIONS FOR MEDICAL BENEFITS

1. Application For Medical Benefits

Applicants must complete an application for medical benefits. Refer to Section M401 for a list of applications.

Applications may be submitted online, emailed, faxed, mailed, or delivered to the Wyoming Department of Health Customer Service Center or the Medicaid Long Term Care Unit, depending upon the type of case.

2. Applications Must Be Date Stamped

Applications must be date stamped with the date/month and year when received. For applications received after hours, on a weekend or holiday, the date stamp would be the first working day after receipt.

3. Applications Must Be Signed

Applicants who submit an application without a signature must sign within 45 days of receipt. The application must be registered, and the applicant must be notified of this requirement. Eligibility cannot be determined until the application is signed.

4. Applications Must Be Complete

Applicants who submit an application that is not complete must provide the information necessary to determine eligibility within 45 days of receipt. The application must be registered and the applicant must be notified of this requirement.

5. Interviews May Be Conducted

Applicants will be allowed the opportunity to conduct an interview by telephone or in person in the Cheyenne office.

6. Applications Must Be Approved Or Denied Within 45 - 90 Days

Applications must be approved or denied within 45 days from the date of application unless waiting for third party verification. In this case, the decision must be made within 60 days.

The only exception is when a disability determination is pending. In this case, a decision must be made within 90 days.

7. Applicants Who Declare U.S. Citizenship Have 90 Days To Provide Verification

Applicants who declare U.S. Citizenship have up to 90 days to provide verification when verification cannot be obtained by the Wyoming Department of Health Customer Service Center or the Medicaid Long Term Care unit, depending upon the case.

A reasonable opportunity period must be provided for individuals who have attested to citizenship or satisfactory immigration status.

Benefits must close when verification is not provided within 90 days.

Reasonable opportunity periods are not limited.

8. Benefits Must Not Be Postponed

Benefits must not be postponed due to delays in other program eligibility determinations/requirements.

9. Applications Are Used To Determine Eligibility For The Month In Which They Are Received Plus The Two Following Months

Applications can be used to determine eligibility for the month in which the application was received by the Agency and the following two months.

If a determination of eligible was not made during the initial three months of application, a new application is required.

10. Agency Receives Information Or Verification After Denial Or Closure Of Application

A new application is required when information or verification is received more than 60 days from denial and 90 days from closure.

Verifications for denied month(s) received within 60 days from a denial and 90 days from a closure can only be used to redetermine eligibility for the month(s) that were denied.

11. Furnish WHIPP Application To Applicants/Clients Who Have Insurance

12. Furnish Estate Recovery Brochure To Applicants

Applicants who are age 55 or older or applicants who are an inpatient in a medical institution may be subjected to Estate Recovery. An applicant must be informed of this requirement by providing the Estate Recovery Brochure. For questions concerning estate recovery contact 855-294-2127.

Medicare Savings programs are not subject to Estate Recovery.

Defining Requirement: 42 CFR 435.905 – 912

Evaluating Applications For WHIPP Participation

1. Refer to Section M411 for information on determining WHIPP participation.

Current Policy Effective Date: January 1, 2014

Date Last Reviewed: April 1, 2015

Previous Policy: July 1, 2004

POL M404: DISTRIBUTING MEDICAID CARDS

1. Medicaid Clients Receive Medicaid Cards

Medicaid cards are distributed to Medicaid clients once they are eligible. It is an insurance card to provide a method for providers to bill.

2. Fiscal Agent Contractor Distributes Medicaid Cards

3. Fiscal Agent Mails Cards within Set Time Frames

Clients or their authorized representatives may inquire about the status of their card by calling the Fiscal Agent Contractor.

4. Replacement Cards May Be Issued

Clients or their authorized representatives may request a replacement card by calling the Fiscal Agent Contractor. Reference Medicaid Table 23 for contact information.

If a Medicaid card was returned to the Fiscal Agent Contractor, the card may be re-mailed upon request.

Defining Requirement: Social Security Act, Title XIX

Cards Cannot be Forwarded to Another Address

1. Postal service is required to return Medicaid cards to the Fiscal Agent Contractor, instead of forwarding to another address.

2. Fiscal Agent Contractor cannot change address. The Customer Service Center or Long Term Care Unit must change address in WES.

Recording Address Changes

1. Receive call from client with new address after card is returned to Fiscal Agent Contractor.

2. Update address in WES.

Current Policy Effective Date: August 1, 2016

Date Last Reviewed: August 1, 2016

Previous Policy: January 1, 2014

POL M406: DEFINING CLIENT RIGHTS

1. Individuals May Apply For Benefits

Individuals may apply for benefits upon request and without delay. Applications must be made on the prescribed form obtained in person, online, or by mail.

Applications may be submitted by submitted online, emailed, faxed, mailed or delivered to the Wyoming Department of Health(WDH) Customer Service Center or the Medicaid Long Term Care Unit, depending upon the type of case.

2. Applicants May Be Accompanied At Interviews

Applicants have the right to be accompanied by the individual(s) of their choice at interviews.

3. Individuals May Designate Authorized Representative

Individuals have the right to designate an authorized representative when applying for or receiving benefits. An authorized representative is defined as a person acting on behalf of a client or an assistance unit. The authorized representative can be added or modified:

In writing by filling out the Appendix C of the Health Coverage Application. Online through the WES client Web Portal. Through the WDH Customer Service Center of Long Term Care Unit via a telephone call.

4. Applicants May An In-Person Or Telephone Interview

Applicants have the right to request an in-person or telephone interview. These interviews can only be conducted in the Cheyenne Medicaid office. Interviews are not required for Family and Children's, Medicare Savings, Employed Individuals with Disabilities, Breast and Cervical or the Tuberculosis programs.

5. Individuals Have Right To Confidentiality

Applicants and clients have the right to have their applications and other personally identifiable information kept confidential, except as necessary to determine eligibility or comply with State or Federal law. Refer to Section M409 for additional information on confidentiality.

6. Individuals Must Receive Certain Information

Applicants and clients must be informed about:

Length of time benefits are authorized. Rights and responsibilities of applicants/clients.

7. Individuals May Withdraw Applications At Any Time

8. Clients Must Receive Notice Of Adverse Action

A notice of adverse action must be sent to the client at least fifteen days prior to case closure.

9. Clients May Request Administrative Hearing

Clients have the right to request an Administrative Hearing within 30 days from the date on the Notice of Adverse Action. The WDH may contact clients for a conference prior to an Administrative Hearing.

10. Clients May Continue To Receive Benefits Pending Administrative Hearing

Clients may continue to received benefits when a hearing is requested before the effective date of the adverse action, unless the request for hearing is denied by the WDH.

11. Individuals May Reapply For Benefits

Individuals may reapply for benefits after having an application denied or a case closed.

12. Clients May Request Retroactive Benefits

Clients may request retroactive Medicaid benefits for up to three calendar months prior to the month of application, except for the following programs:.

Qualified Medicare Beneficiary Program. Waiver Programs. Hospice Care. Tuberculosis Assistance Program.

Defining Requirement: 42 CFR 435.905 – 912 or 435.610

42 CFR 431.200

Withdrawing Applications

1. Document case record when withdrawal is requested in writing or verbally.

2. Withdraw case in WES per withdraw request.

3. Send denial Application Withdrawn notice.

Current Policy Effective Date: January 1, 2014

Date Last Reviewed: April 1, 2015

Previous Policy: January 1, 2010

POL M407: DEFINING CLIENT RESPONSIBILITIES

1. Applicants Must Complete Application

Applicants must complete an application for medical benefits.

2. Applicants Must Submit Application

Applications must be submitted to the Wyoming Department of Health Customer Service Center or the Medicaid Long Term Care Unit, depending on the type of case.

3. Applicants Must Cooperate With Eligibility Determination Process

Applicants must cooperate with the eligibility determination process by doing one or more of the following:

Participate in an interview when applying for the Long Term Care programs. Provide verification of citizenship and identity or immigration status, when required. Provide verification of eligibility factors, when required. Provide information essential to make an eligibility decision. Provide verification of income, when required Provide verification of date of birth, when required. Provide SSN or proof of an SSN application, as specified in Section M603 , when required.

4. Applicants/Clients Must Notify State Of Changes Affecting Eligibility

Changes impacting eligibility must be reported within ten (10) calendar days.

Reference Section M1601 for additional information on reporting changes.

5. Clients Must Provide Information Within Fifteen (15) Days

Clients must provide information, documentation or verification within fifteen (15) calendar days of request.

6. Applicants May Declare Medical Expense Information

Applicants requesting retroactive Medicaid benefits, may declare on the application that medical expenses were incurred.

7. Applicants/Clients Must Provide Health Insurance Information

8. Applicants/Clients May Need To Provide Child Support Information

Applicants/Clients must provide information to assist in establishing paternity and obtaining medical support and payment, when required by the program.

Defining Requirement: 42 CFR 435.905 – 910

Current Policy Effective Date: November 1, 2015

Date Last Reviewed: November 9, 2015

Previous Policy: January 1, 2007

POL M408: CASE FILE MAINTENANCE

1. Record Narratives

Narratives should be documented, in a case note on WES, every time an action is taken on the case. Refer to Section M408A .

2. Review Case Files Annually

Determine which records qualify for disposition or need to be purged.

3. Maintain File Records

File maintenance responsibilities include the following:

Purging Case Files. Archiving Case Files. Refer to Section M408B.

Paper Files: W.S. 9-2-401, 9-2-405 – 413

Written Application: 42 CFR 435.907

Availability of Program Information: 42 CFR 435.905

Notice of Agency Decision: 42 CFR 435.912

Documenting the Case File: 42 CFR 435.913

Recording Narratives

1. Record the actual events and facts.

2. Be as complete and concise as possible.

3. Use standard abbreviations and clear punctuation.

4. Document events as they occurred, in chronological order.

5. Document by entering a case note promptly in WES.

Purging Case Files

1. Transfer all hard copies of family information to the new file (i.e., birth certificates, divorce decrees, etc.) and file under the Initial/Permanent/Verifications divider (102I).

2. Transfer the entire case narrative.

3. Retain all applications for not less than six years or for the current period of eligibility without a break-in-aid even if more than six years old.

4. Review the case for any previous overpayments and file all applicable information/verification that supports the overpayment under the Recovery/QC Errors/Fair Hearing divider (102J).

5. Destroy all other information more than six years old if the information is not needed to support an overpayment or any other possible issue within the case.

6. Indicate on the front of the folders “1 of 2”, “2 of 2”, etc. and retain prior files.

Archiving Case Files

1. Place the case file in archive boxes by alpha order.

2. Number the boxes using the system established by your field office.

3. Type an alpha list for each box listing:

3A. Box number.

3B. Case name.

3C. Case number.

3D. Date of record.

4. Print alpha list.

5. Make three copies of the alpha list.

6. Place one copy inside box on top of files.

7. Attach one copy to Records Center AR9 form.

8. Retain one list in the field office.

9. Complete and place the required label on the archive box.

Retrieving Archived Case Files

1. Send an email to Records Center containing the following information:

1A. Box number.

1B. Case name.

1C. Case number.

1D. Date of record.

1E. Medical Assistance #.

1F. Record Center location.

Current Policy Effective Date: July 1, 2006

Date Last Reviewed: May 23, 2007

Previous Policy:

POL M408A: CREATING NARRATIVES

1. Narratives Must Be Factual

Narratives must record actual events and facts. They must not contain speculation or emotional reactions.

2. Narratives Must Be Complete and Concise

3. Narratives Must Be Clear

Narratives do not need to be in complete sentences. Standard abbreviations and clear punctuation must be used.

4. Narratives Must Be Accurate

Narratives must list events as they occurred, in chronological order.

5. Narratives Must Be Recorded Promptly

Narratives must be recorded as soon as possible, not reconstructed at a later time or date.

6. Narratives Must Be Legible

Narratives must be able to be read by others and written with a word processing program whenever possible.

7. Narratives Must Answer Questions Not on Applications

Narratives must be written to answer any questions that are not clear on the application, including, but not limited to:

When did the applicant come in or call? Why did the applicant contact you? Who is contacting you? What program(s) is the applicant applying for or what change was reported? Where does the applicant work? How long will employment last?

Discrepancies between information in the case file/application and information being provided by the individual must be recorded.

8. Narratives Must Demonstrate How Eligibility Determined

Narratives must clearly show how the eligibility decision was made, including:

How the best estimate was determined. Start and stop date of work. How often client receives pay, listing actual pay dates. Hourly wage and number of hours worked per week. Bonuses, overtime schedule, commissions, tips, shift differential, etc. Why income was counted or excluded. Excel spreadsheet, if used. Income calculations, when Excel spreadsheet not used. How the vehicle value was determined. Why resources were used and how values were determined. Who was included in the benefits and why others were excluded. Record if Medicaid was offered to family members and if they refused.

9. Narratives Must Include Certain Information

Narratives must include the following information:

Third party involvement (such as a representative), including names, dates, and phone numbers. Supportive statements for eligibility decisions, including denials and closures. Whether someone attended with the individual, such as a family member, friend, or an interpreter. Document that client was informed of rights and responsibilities.

10. Narratives Must Be Entered When Contact Made with Clients

Narratives are necessary for each instance contact is made with clients or action is taken on a case.

11. Case Files Must Note if Clients Pose Danger to Workers

Workers must be aware and make others in the office aware if clients are potentially dangerous. Follow current office protocol in these cases.

12. Narratives Must Be Initialed or Signed

Defining Requirement: 42 CFR 435.913

1. A Case Narrative Is Defined as :

A State record and may be reviewed by other Benefit Specialists, supervisors, managers, consultants, quality control investigators or other state employees.

A record that may be used as evidence in court or for an administrative hearing.

A record of pertinent, historical facts and must be clear, concise, and accurate.

Documentation of the eligibility determination.

Current Policy Effective Date: April 1, 2006

Date Last Reviewed: May 16, 2007

Previous Policy:

POL M409: MAINTAINING APPLICANT AND CLIENT INFORMATION CONFIDENTIALITY

1. Information Relating to Specific Individuals Must Remain Confidential

The following information must remain confidential:

Names, addresses, and SSNs of applicants and clients. Documents naming an individual(s). Personal facts relating to an individual(s). Application. Receipt of benefits. Information relating to social and economic conditions of individual(s), including information from IRS, SSA, and other agencies. Safeguard information from other agencies in accordance with their procedures. Medical data, including psychological evaluations. Any information known about individual(s), but not part of case record(s) or document(s).

Defining Requirement: 42 CFR 431.306 – 307

1. Confidentiality Is Defined As The Limitation Of The Use And Disclosure Of Applicant And Client Information.

Safeguarding Personal Information

1. Shred documents containing personal information when files are purged according to policy or when document is no longer needed.

1A. Do not throw in garbage.

Current Policy Effective Date: April 1, 2006

Date Last Reviewed: May 23, 2007

Previous Policy:

POL M410: SAFEGUARDING AND RELEASING INFORMATION

1. Public Records Must Be Made Available

Public records must be made available to the public upon request and with the approval of the Program Manager or designee.

2. Public Records Must Not Contain Personal Information

Public records may contain any of the following:

General information not identifying individuals.

Statistical information related to budgets, expenditures, or applicant’s/client’s other information, not identifying individuals.

Information about Medicaid-related policies and procedures.

3. Case Records May Be Examined, Reviewed, or Copied

Clients or their authorized representatives are permitted to examine, review, or copy from their case records except the following confidential information:

Names of individuals or other parties who have disclosed information about the client without their knowledge. Reports, correspondence, or any case entry involving information from another individual, agency, organization or institution about the client. Information related to the status of prosecution of the client.

4. Authorization to Release Information Is Limited to Eligibility Determination

Only information needed to determine eligibility may be collected when the information is authorized for release on an application.

5. Medical Information May Be Released to Third Parties

Medical information must be released to the client directly by a medical/mental health professional, unless written authorization from the health professional is received prior to release.

Medical and psychological information provided by health care professionals may not be exchanged with other agencies unless the client specifically authorizes the exchange in writing.

6. Confidential Information May Be Released

Individuals must complete a release of information form for confidential information to be released to another governmental body, a court, or law enforcement individuals.

7. Materials Released Must Be Directly Related to Medicaid

All materials released to applicants, clients, or medical providers must be directly related to the administration of Medicaid programs.

8. Certain Materials May Be Distributed to Applicants/Clients

Materials directly related to the health and welfare of applicants/clients may be distributed. This may include announcements of free medical examinations, availability of surplus food and consumer protection information.

9. Applicant and Client Names Must Not Be Published

Defining Requirement: 42 CFR 431.306 – 307

Do Not Charge Individuals/Agencies for Copying Information Related to Adverse Actions or Administrative Hearings.

This section of the policy manual contains the basic non-financial eligibility rules for Medicaid programs. These basic non-financial rules apply to all types of medical assistance, unless this manual specifically states otherwise.

Current Policy Effective Date: January 1, 2019

Date Last Reviewed: May 10, 2019

Previous Policy: May 18, 2018

POL M601: DETERMINING BASIC ELIGIBILITY - RESIDENCE

1. Applicants Must Be Wyoming Residents

Applicants must be living in the State of Wyoming voluntarily and with the intention of establishing a permanent residence in the state.

2. Applicants Moving From Another State Have 45-Day Application Period

Applicant must reside in WY within the 45-day application period.

3. Applicants Without Permanent Address May Be Eligible for Services

Applicants who do not have a permanent home address or permanent dwelling may receive benefits. A general Wyoming address may be used.

4. Clients May Receive Benefits From Another State In Initial Month

Applicants may receive benefits from Wyoming and another state in the initial month of eligibility. This may occur when a client is moving from another state to Wyoming.

5. Clients May Continue Receiving Benefits if Residency is Interrupted

Clients may continue to receive services if the eligibile person meets the criteria of temporary absence. Refer to Section M605 to determine if temporary absence criteria are met.

Defining Requirement: 42 CFR 435.403

Current Policy Effective Date: August 1, 2018

Date Last Reviewed: August 1, 2018

Previous Policy: August 1, 2016

POL M602: DETERMINING BASIC ELIGIBILITY - IDENTITY

1. Applicants Must Prove Identity

Identity must be verified for all Medicaid applicants, except when applying for the following programs:

Emergency Services. Basic Foster Care. Institutional Foster Care.

For all other Medicaid applicants, refer to Medicaid Table 5 for acceptable verifications of identity.

2. Applicants Born To Medicaid Eligible Mother

Verification of identity is not required for any applicant who was born to a Medicaid eligible mother in Wyoming, during their life time.

Defining Requirement: Social Security Act § 1903

Current Policy Effective Date: January 1, 2014

Date Last Reviewed: October 22, 2015

Previous Policy: April 1, 2006

POL M603: DETERMINING BASIC ELIGIBILITY – SOCIAL SECURITY NUMBER

1. Applicants Must Provide Social Security Number

Applicants who will be receiving benefits are required to provide a Social Security Number (SSN). Applicants may also provide proof of application for SSN.

Applicants who do not provide an SSN or proof of application for SSN will be denied, except for the following programs:

Emergency Services Newborn born to Medicaid Mother

2. Non-Citizen Applicants May Receive SSNs

The SSA may assign an SSN for non-citizen applicants when federal, state, or local statute or regulation, in accordance with federal law, requires the non-citizen to provide SSN to receive benefits.

This applies to non-citizens without USCIS work authorization. Those with USCIS work authorization should already have an SSN assigned.

3. Non-Citizen Applicants Without SSN May Receive Emergency Services

Reference Section M1205 for information on Emergency Services.

4. Applicants With A Well Established Religious Objection Do Not Have To Provide An SSN

Defining Requirement: 42 CFR 435.910

Children transitioning from the newborn to the Child MAGI program at one year of age are required to provide an SSN.

Assisting Lawful Non-Citizen Applicants in Obtaining SSN

1. Verify that the non-citizen applicant does not have US Citizenship and Immigration Services (USCIS) authorization to work in the US.

2. Determine the non-citizen meets eligibility requirements, except SSN.

3. If non-citizen applicant meets eligibility requirements, obtain evidence of the following:

3A. Age.

3B. Identity.

3C. Lawful status.

4. Submit above information to local SSA in a statement on agency letterhead that includes the following:

4A. Identity of non-citizen applicant.

4B. Reason SSN is required.

4C. Statement that non-citizen applicant meets all requirements to receive benefits except the SSN.

Verifying USCIS Authorization

1. Use SAVE process outlined in Section M604 .

OR

2. Obtain verification from USCIS using process outlined in Section M604 .

Current Policy Effective Date: April 1, 2021

Date Last Reviewed: April 1, 2021

Previous Policy: August 1, 2016

POL M604: DETERMINING BASIC ELIGIBILITY – CITIZENSHIP/IMMIGRATION STATUS

1. Applicants Must Meet Citizenship/Immigration Eligibility Requirements

Applicants must be a U.S. Citizen by birth or naturalization.

OR

Applicants must meet at least one of the Qualified Immigrant status requirements outlined in Medicaid Table 6 .

Applicants under one of the following programs are not required to meet the citizenship requirements:

Emergency Services.

Basic Foster Care.

Institutional Foster Care.

2. Applicants Born to Medicaid Eligible Mother

Verification of citizenship is not required for any applicant who was born to a Medicaid eligible mother in Wyoming during their life time.

3. Revenue Information System (RIS) Can Be Used To Verify Citizenship

Verification of citizenship can be obtained by using the Revenue Information System (RIS) in EPICS. When verification is not available in RIS refer to Medicaid Table 5 for acceptable verification of citizenship.

4. US Citizens and Qualified Immigrants Must Verify

Applicants must verify U.S. Citizenship by birth or naturalization, except a child who is born to a Medicaid eligible mother. Refer to Section M301A for factors requiring verification and Medicaid Table 5 for Evidence of Citizenship.

Applicants must verify Qualified Immigrant status requirements. Refer to Medicaid Table 5A for evidence of immigration status.

5. Foreign Born Children May be Eligible

Children who were born in a foreign country and living in the US, and children adopted from a foreign country by US citizens, are automatically granted citizenship if the following conditions are met:

Child is under age 18.

Child was admitted to the US as a Lawful Permanent Resident Immigrant.

Child is in the legal and physical custody of at least one parent that is a US citizen.

Defining Requirement: 42 CFR 435.406

Applicants in the U.S. under the Deferred Action Childhood Arrival Act (DACA) are not considered lawfully present for Medicaid purposed. DACA is indicated with a Category C33 on a U.S. Employment Authorization Card.

Using Wyoming Birth Cert Application Tab

1. Click on the Birth Cert App. tab (this tab is password protected).

2. Enter your user name and password, and then click the OK button.

3. Enter the first and last name or initials of the first and last name, and date of birth (mm/dd/yyyy).

4. Click the search button, which will reveal the results

5. If individual is found, record file number in narrative and print copy for case file.

6. If individual is not found, request verification of citizenship from the applicant.

7. If the applicant is not able to provide citizenship verification, contact the Eligibility Unit for assistance before denying the case.

Verifying Immigration Status With Systematic Alien Verification for Entitlements (SAVE)

1. Obtain one or more of the following pieces of documentation of immigration status:

1A. Documentation of immigrant registration.

1B. Alien Registration Number (A-Number).

1C. Another form of documentation that the agency issuing the documentation has determined to be reasonable evidence of the individual’s immigration status.

2. Include documentation of immigration status in applicant’s case file.

3. Verify immigration status using the WEB-1 Access Method.

3A. See the SAVE Manual, Section 2 for procedures for using Primary Touch-Tone SAVE Access.

3B. Use this website address: https://save.uscis.gov/WebOne/

4. For applicants without USCIS documentation, verify date of entry into the United States or date immigration status was granted.

5. Submit USCIS Form G-845 by mail to:

U.S. Citizenship and Immigration Services

300 N. Los Angeles Street, B120

Los Angeles, CA 90012

Attn: Immigration Status Verification Unit

Using Revenue Information System (RIS) for Citizenship

1. Access Revenue Information System (RIS) through the Mainframe at the TPX menu. Refer to Section M301B for instructions on accessing RIS.

Verifying Eligibility for Victims of Trafficking

1. Confirm the validity of the certification letter by calling the Trafficking Verification Line at (202)401-5510.

2. Record the expiration date of the certification letter in each applicant’s file.

3. Set an alert with the expiration date.

4. Conduct a review to determine continued eligibility.

Other Coding Requirements for Immigrant Applicants

1. Refer to Medicaid Table 20 for the SDX immigrant codes and their definitions.

Current Policy Effective Date: January 1, 2019

Date Last Reviewed: May 10, 2019

Previous Policy: November 1, 2016

POL M605: DETERMINING BASIC ELIGIBILITY – TEMPORARY ABSENCE

1. Individuals Must Meet Temporary Absence Criteria

Individuals meet the criteria for Temporary Absence when they leave the state with the intent to return to Wyoming within three months.

Individuals continue to meet the temporary absence criteria, after three months, when the following conditions are met:

Individual is in another state to get prescribed medical treatment not available in Wyoming and intends to return to Wyoming once the medical treatment is complete. Temporary absence is due to the illness of the individual or the individual’s parent, spouse, sibling or child. A child in the custody of the State is placed in an out-of-state facility, unless the child is covered by the other state. Individual’s employer requires them to work out of state.

Consider the individual continuing to reside in their assistance and a Wyoming resident when the above conditions are met.

Individuals do not meet the temporary absence criteria when they apply for Medicaid or establish residency in another state.

Defining Requirement: 42 CFR 435.403

This section defines resources and explains how they should be counted, ownership, transferring resources, transfer penalties, trusts, spousal resource assessments, and treatment of resources.

Current Policy Effective Date: April 1, 2021

Date Last Reviewed: October 1, 2025

Previous Policy: March 26, 2021

POL M801: COUNTING RESOURCES

1. Most Aged, Blind, and Disabled Programs and Medicare Savings Programs Count Resources

Resources are exempt from consideration for the EID Program.

2. Resources of Spouse May Be Available to Other Spouse

Resources of a spouse are available to the other spouse.

Resources of a spouse are not available the month after the marriage ends or the month after the married couple are separated and not living in the same household.

3. Resources of Parent(s) May Be Available to a Child

The resources of a natural parent, adoptive parent or stepparent are available to a child except:

A child who is disabled and has received or is receiving SSI while in an institution. A child who is applying for the Comprehensive, Support or Children’s Mental Health Waiver.

4. Proceeds From Selling an Resource Must Be Considered Resources

Proceeds from the sale of an exempt or nonexempt resource are countable and the client must be within the maximum resource limit to remain eligible. Refer to Table 7 to see resource standards.

5. Equity Value Must Be Calculated

The equity value of a resource is calculated by using the cash, trade-in, or current market value and subtracting the unpaid principal or amount of the lien(s). Equity value is used to determine eligibility.

6. Fair Market Value (FMV) Is Selling Price

Current or FMV is the selling price on the open market as set by current standards. FMV may be determined by a market analysis or appraisal by a realtor, or other knowledgeable sources who are familiar with property values in a given community.

7. Resources May Be Re-Appraised

An applicant or client may obtain a new appraisal for a resource when the value of a resource(s) causes ineligibility and the applicant or client disputes the value.

8. Commingled Resources May Be Exempted

Exempt resources commingled with non-exempt resources when identifiable.

Assistance units should be encouraged to separate exempt and nonexempt resources.

9. Resources Must Be Evaluated from the First of the Month

10. Income Must Not Be Counted as a Resource in First Month

Calculate the available bank account balance, by deducting any income received in the first month, when the individual is over the maximum resource limit.

11. Acquired Resources and Resources Increasing in Value Count in Next Month

Resources acquired within a month and resources increasing in value are counted in the following month.

12. Outstanding Checks Must Be Considered Legal Encumbrances

Outstanding checks must be considered legal encumbrances when evaluating a checking account. Deduct any outstanding checks written and delivered to the payee prior to the first of the month that have not cleared, when the individual is over the resource limit.

13. Qualified Long Term Care Insurance Partnership Policies Must Be Reviewed by WDH

Qualified Long Term Care Insurance Partnership policies must be sent to WDH to determine if the policy meets the criteria of a qualified partnership policy.

14. Resources May Be Disregarded through a Qualified Long Term Care Insurance Partnership

Disregard any resources claimed by the applicant in an amount equal to or less than the benefits paid on behalf of the individual by a Qualified Long Term Care Insurance Partnership policy for the following programs:

Institutional Related HCBS Waivers

The disregarded resources can include a resource that is exempt for eligibility but not for estate recovery (i.e. home).

Defining Requirement: 20 CFR 416, Subpart L

42 CFR 435, Subpart G

Determining Countable Resources

1. Refer to Medicaid Table 8 for information on Countable Resources.

Determining Amount of Resources that Can Be Disregarded Through A Qualified Long Term Care Insurance Partnership Policy

1. Disregard the resources claimed on the Qualified Long Term Care Insurance Partnership Asset worksheet in an amount equal to or less than the benefits paid on behalf of the individual by a Qualified Long Term Care Insurance Partnership policy.

2. Applicant must claim these resources at initial application and then additional resources at review.

3. Additional resources can be exempted as the policy continues to pay towards the long term care services.

Example:

Qualified Long Term Care Insurance Partnership Disregard

Example 1

A Qualified Long Term Care Insurance Partnership policy has paid $50,000 on behalf of John Doe. Mr. Doe has a CD worth $50,000 that was claimed on the Qualified Long Term Care Insurance Partnership Asset worksheet, this amount can be disregarded before testing against the resource standard. Mr. Does is eligible for benefits.

Example 2

A Qualified Long Term Care Insurance Partnership policy has paid $75,000 on behalf of Jane Smith. Mrs. Smith has a savings account worth $75,000 that was claimed on the Qualified Long Term Care Insurance Partnership Resource worksheet. In addition she has real property worth $25,000. The $75,000 can be disregarded, the $25,000 is a countable resource and must be tested against the standard. Mrs. Smith is not eligible for benefits.

Determining Resource Values of Registered Vehicles

1. Use the VIN number of vehicle(s) or the year, make, and model to calculate a value on

Edmund’s https://www.edmunds.com/appraisal/ or on JD Power https://www.jdpower.com/cars .

a. Please note that if the vehicle is 25 years or older these sites may be unable to provide a valuation. Certain vehicle types are unable to be valued through these sites. Whenever a value cannot be calculated one will need to be requested of the client from a reputable dealer.

2. If the vehicle in question is actually a flatbed trailer, use the purchase price, depreciation (10%), and age of the trailer to calculate the value on Academy https://calculator.academy/trailer-value-calculator/ .

a. If this is a different trailer type or all factors needed for the calculation cannot be obtained a valuation will need to be requested of the client from a reputable dealer.

Current Policy Effective Date: October 1, 2025

Date Last Reviewed: October 1, 2025

Previous Policy: July 1, 2007

POL M802: DETERMINING RESOURCE OWNERSHIP AND AVAILABILITY

1. Resources Are Unavailable When Legal Barrier Exists

A legal barrier is defined as an inherent legal restriction on the right to sell, convey or transfer the client's share or ownership of a resource.

2. Resource Ownership Implies Resource Availability

3. Fund Availability May Be Assumed

All funds may be assumed available to the applicant/client when there are multiple owners of a bank account, CD, or other resources and the other owner is not a Medicaid client.

4. Resources May Be Considered Available

Resources or portions of resources are considered available when any of the following conditions apply:

Individual can withdraw funds. Individual can sell resource or owned interest in the resource. Individual can dispose of the resource in any way. Resources, or portions of resources, owned by multiple people can be accessed without permission of co-owner, even when statement of refusal to sign is furnished.

5. Resources May Be Considered Unavailable

Resources are considered unavailable when any of the following is true:

Document or signature card stipulates more than one signature is needed to withdraw or convert all or part of the resource to available cash, and the other owner(s) refuses to sign. Applicant or client can no longer withdraw from the account. Applicant or client has been removed from the account Funds have been removed by the other account holder(s). Account has been redesignated.

6. Individuals May Dispute Ownership of Funds

Individuals may dispute the ownership of funds in a Financial Institution and they must:

(i) Submit his/her statement, along with corroborating statements from other account holders, regarding:

Who owns the funds in the joint account

why there is a joint account

who has made deposits to and withdrawals from the account

and how withdrawals have been spent

(ii) Submit account records showing deposits, withdrawals, and interest (if any) in

the months for which ownership of funds is at issue; and

(iii) Correct the account title to show that the individual is no longer a co-owner if

the individual owns none of the funds; or, if the individual owns only a portion of

the funds, separate the funds owned by the other account holder(s) from his/her

own funds and correct the account title on the individual's own funds to show they

are solely-owned by the individual.

7. Individuals Must Be Aware of Resource Ownership

Resources are not available during a period when the individual was unaware of their ownership. Resources must be counted the month following discovery.

Defining Requirement: 20 CFR 416, Subpart L

42 CFR 435, Subpart G

Wyoming Statute Definition of Property Ownership

Real property is fixed, permanent or immovable, this includes land, houses, buildings or mobile homes. Unless there is a legal condition of ownership specifically prohibiting sale of any part of the resource without permission of all owners, the client's share is an available resource.

Definition of Joint Tenancy

Joint tenants have legal ownership where both parties have undivided interest in a piece of property. Both equally own the entire property. The joint tenancy ends when one of the two individuals dies. At that point in time, the survivor solely owns the entire property. No heirs inherit from the person who died. Neither party may convey or encumber his or her interest in the property without the consent of the other.

Definition of Joint Tenancy with Survivorship

This is identical to Joint Tenancy. The right of survivorship is the term required in Wyoming to allow the surviving joint tenant to claim their interest after the death of the other tenant. This title is needed to keep heirs from inheriting the property.

Definition of Tenancy in Common

Each tenant (owner) holds an undivided interest in the property. However, unlike a joint tenancy by the entirety, the interest of the tenant does not terminate upon his or her death. Their interest will go to their heirs or the estate.

Definition of Ownership by Entireties

This is identical to Joint Tenancy, and created between a husband and a wife.

Current Policy Effective Date: February 1, 2021

Date Last Reviewed: March 25, 2022

Previous Policy: March 1, 2019

POL M803: TRANSFERRING RESOURCES

1. Resource Transfers Occur When Ownership Is Reduced Or Is Eliminated

A resource transfer occurs when any action is taken that reduces or eliminates an individual’s ownership or control of the resource.

2. Transfer Provisions Do Not Apply To Certain Programs

Transfer provisions do not apply to the following programs:

Family and Children’s. Inpatient Hospital Care. Hospice. Tuberculosis. Medicare Savings Programs. Supplemental Security Income (SSI).

3. Certain Types Of Transfers Are Exempt

The following must be considered exempt transfers:

Legally enforceable debt settlement. Clearing title to property in which the client had no beneficial or enforceable interest. Equity in property, which was owned jointly, if other owner was granted equity through a court action. Resources sold, traded or transferred at fair market value. Resources transferred to an approved Special Needs, Pooled or Income Trust.

4. Transfers To Certain Individuals Are Exempt

The following transfers must be considered exempt:

Home property was transferred to the individuals: Spouse. Child under age 21. Child of any age who is blind or disabled. Verify through one of the following sources: SOLQ; Letter from SSA; Collateral Contact with SSA; or SDX or BDX interfaces Sibling who has equity interest in the home and who resided in the home for at least one year immediately prior to the date of admission to a medical facility or eligibility for the Home and Community Based Services Program. Refer to Table 5B for acceptable verifications to prove the sibling resided in the home for the required time period. Son or daughter resided with the parent for a period of at least two years immediately prior to the date of admission to a medical facility or eligibility for the Home and Community Based Services Program and provided care in the home. Require the following verifications: Refer to Table 5B for acceptable verification to prove the son or daughter resided in the home for the required time period; Affidavit of Caretaker ( DHCF 400 ); and Physician Statement ( DHCF 402 ). Non-Home property was transferred to the individuals: Spouse; or Another person for the sole benefit of the transferor's spouse; or Child of any age who is blind or disabled. Verify through one of the following methods: SOLQ; Letter from SSA; Collateral Contact with SSA; or SDX or BDX interfaces.

5. Clients Must Demonstrate Intention And Evidence To Exempt Resource Transfers

Clients must show they intended to dispose of the resource at fair market value or for another valuable consideration.

Clients must demonstrate the intent of the transfer was not for Medicaid eligibility purposes. Evidence provided must show:

The transfer was court ordered (provided the claimant took no action to petition the court to order the transfer). At the time of transfer, the individual could not have anticipated the need to apply for eligibility (e.g., the individual became disabled following a traumatic accident, but was not disabled when the transfer occurred). After the transfer, there was a traumatic onset of disability (e.g., traffic accident or a diagnosis of a previously undetected disabling condition). Total countable resources, including the transferred resource, were below the resource limit at all times from the month of transfer through the present month. Denial of eligibility would result in undue hardship.

6. Nursing Facility Payment Withheld For Nonexempt Resource Transfers

If clients transfer nonexempt resources for less than fair market value, but meet all other eligibility factors, a penalty period must be imposed. During the penalty period:

Payment for nursing home facility services must be withheld, and benefits authorized for the Medicaid Services Only Program.

7. HCBS Waiver Eligibility Delayed For Nonexempt Resource Transfers

Process for manually calculating the penalty period and communicating the length to the Community Based Services Unit or the Behavioral Health Division/Developmental Disabilities Section:

The penalty period for a Waiver applicant begins from the time both financial eligibility and medical necessity are met. A plan of care is not required to start the penalty period. Contact the Community Based Services Unit or the Behavioral Health Division/Developmental Disabilities Section with the end date of the penalty period to prevent Waiver services from being paid until completion of the penalty.

8. Transferred Resources May Be Returned

Transferred resources causing ineligibility may be returned. When this occurs, no penalty for the transfer is assessed.

Retroactive adjustments must be made for returned resources that initially resulted in a penalty and denied benefits.

Returned resources are counted in the first month following the month of return.

Defining Requirement: 20 CFR 416, Subpart L

42 CFR 435, Subpart G

Social Security Act 1917

Current Policy Effective Date: September 1,2018

Date Last Reviewed: April 8, 2026

Previous Policy: August 27, 2018

POL M804: DETERMINING RESOURCE TRANSFER PENALTIES

1. Penalties Apply To Non-Exempt Resource Transfers

Penalties for transferring a resource must be applied when applicants or clients cannot provide proof the transfer occurred for reasons other than gaining or maintaining eligibility. The transfer amount must also meet or exceed the average daily rate for Nursing Homes in order to be assessed due to the penalty calculation.

2. Determining Uncompensated Value Of Transfers

The uncompensated value of a transfer is calculated by using 80% of the current market value of the transferred resource and deducting all of the following that apply:

Amount of the lien(s). Unpaid principal of the mortgage or loan existing against the resource. Any compensation received.

Example 1: Current market value - $100,000 x 80% = 80,000 - $40,000 (Mortgage) - $40,000 (Compensation received) = $0 (no transfer penalty)

Example 2: Current market value - $80,000 x 80% = 64,000 - $40,000 (Mortgage) = $24,000 (amount of transfer penalty). See Table 9 on how to calculate the penalty period.

The uncompensated value of jointly owned resources is calculated by using 80% of the current market value of the applicant or client's interest in the transferred resource, and deducting any compensation received for the resource.

3. Calculating Transfer Penalties

The uncompensated transfer value of the resource should be divided by the average private pay rate, refer to Table 1A .

Penalties must be figured on all days affected by the transfer. Reference Table 9 to determine the look back and penalty period.

4. Transfer Penalty Must Be Split Between Spouses

The transfer period must be split between two spouses if:

An institutionalized spouse has a transfer penalty due to a transfer made by the community spouse. AND The community spouse later becomes institutionalized.

The remainder of the penalty period must be assigned to the surviving institutionalized spouse if one spouse dies.

5. Transfer Penalty Waived For Undue Hardship

The transfer penalty must be waived if imposing the penalty would result in undue hardship, as determined by the Wyoming Department of Health (WDH).

Defining Requirement: 20 CFR 416, Subpart L

Documenting Transfer Penalties

1. Document date transfer occurred.

2. Document calculation used to determine uncompensated value of transferred property.

3. Document when penalty begins and ends.

Calculating Split Delayed Eligibility for Spouses

1. Determine number of months remaining in delayed period of eligibility.

2. Subtract from the original number.

3. Split between couple.

Establishing Undue Hardship

1. Receive Medicaid Hardship Exception Request (DHCH-303) from client.

2. Require the following verifications to be provided:

2A. Medicaid Hardship Exception Physician Statement DHCF-304 .

2B. Require the client to meet one of the following criterion:

Receiving party cannot be located by the individual, spouse, fiduciary, or an agent of the nursing facility and all attempts to locate the receiving party have been exhausted; Transferred resource was due to theft, fraud, or financial exploitation of the individual or their spouse, which has been reported and pursued through Adult Protective Service or law enforcement; or The individual has exhausted all reasonable legal means to recover or regain possession or obtain fair market value of the transferred resource. This may include seeking the advice of an attorney and pursuing legal or equitable remedies, such as asset freezing, assignment, or injunction; seeking modification, or nullification of a financial instrument, cooperating with any attempts to recover the transferred asset.

3. Approve undue hardship when client meets the criteria above and has provided the physician statement and required verifications.

Current Policy Effective Date: November 1, 2015

Date Last Reviewed: September 18, 2015

Previous Policy: July 1, 2007

POL M805: DETERMINING TREATMENT OF RESOURCES WITHIN TRUSTS

1. Trusts Established by Client or Others May Be Considered Client Established

The client will be considered to have established a trust if any of the individuals listed below established a trust using the client’s resources:

Client. Client’s Spouse. Person, including a court or administrative body, with authority to act on behalf of client. Person, including a court or administrative body, acting at the request of the client or the client’s spouse.

2. Trust Establishment Purpose May Be Irrelevant

The purpose for which a trust is established is irrelevant except in the case of a trust established in any of the following circumstances:

Trust established by a will with the client as a beneficiary, who has no current access. In this case, the resource is exempt until the client has access. Trust established for a disabled individual under age 65. In this case, the resource is exempt. Trust established containing resources of the client and resources of any other person. In this case, the client’s resources in the trust must be considered (nonexempt).

3. Revocable Trusts and Payments Are Considered Assets or Income

The entire amount of the trust must be considered as an available resource.

Any payments from the trust to or for the client must be counted as income.

Payments from the trust for any other purpose must be considered an uncompensated transfer of resources.

4. Irrevocable Trusts and Payments Are Considered Assets or Income

Any possible distributions to or for the client must be considered countable resources

Payments from the trust to or for the client must be considered countable income.

Payments from the trust for any other purpose must be considered an uncompensated transfer of resources.

If a trust was established during the 60-month look-back period, any part of the trust that cannot be paid out under any circumstance must be considered an uncompensated transfer of resources.

If any part of the trust is available until a specific date or event occurs, the date the trust becomes unavailable must be considered as the date of the uncompensated transfer for consideration of the 60-month look-back period.

5. Resources Are Not Counted When State Is Residual Beneficiary

Resources must not be counted and transfer penalties must not be developed for trusts where the State is named the residual beneficiary. This means the State is entitled up to the amount of medical expenditures made on behalf of the individual.

6. Trusts for Disabled Individuals May Be Special Needs Trusts

A trust for a disabled individual must meet both the following criteria to be considered a special needs trust:

An irrevocable trust containing the resources and designating as the beneficiary an individual under age 65 who is disabled. Established for the benefit of the disabled individual by a parent, grandparent, legal guardian of the individual, or a court.

7. Pooled Trusts May Be Special Needs Trusts

A pooled trust must meet all of the following criteria to be considered a special needs trust:

An irrevocable trust established by a nonprofit organization. Contain a separate account for each beneficiary, but for purposes of investment and management of funds, the trust pools these accounts. Separate accounts are established solely for the benefit of a disabled individual by the individual, the parent, grandparent, legal guardian of the individual, or by a court.

8. Income Trusts (Miller Trusts) May Be Special Needs Trusts

An Income Trust (Miller Trust) must meet all of the following criteria to be considered a special needs trust:

Created for the purpose of making the income beneficiary eligible for Medicaid. Trust is irrevocable. Consists only of pension, Social Security and other income to the beneficiary listed in Schedule A. Provides for a monthly distribution equal to the income level for the applicable Medicaid group. Monthly distribution is used to pay the cost of nursing facility services or HCBS furnished to the client.

Defining Requirement: 20 CFR 416, Subpart L

42 CFR 435, Subpart G

The Omnibus Reconciliation Act (OBRA) of 1993 Changed How Assets in Trusts Affect Eligibility.

Approving Income Trusts (Miller Trusts)

1. Compare established trust to model in the Miller Trust form .

2. Forward trusts not according to model to WDH for approval.

3. Approve if trust set up according to model.

4. Distribute copy of model trust upon request.

5. Mail copy of approved trust to WDH along with verification showing bank account has been established and power of attorney.

Current Policy Effective Date: November 1, 2015

Date Last Reviewed: September 18, 2015

Previous Policy: January 1, 2014

POL M806: ASSESSING SPOUSAL RESOURCES

1. Countable Resources Of Couple Must Be Assessed

Assess the combined countable resources of a couple when requested by either member of a couple or a representative acting on behalf of either spouse.

2. Spousal Resource Allowance Must Be Deducted

Determine the total countable resources of the couple. Subtract the spousal resource allowance (refer to Medicaid Table 7 ) from the couple’s total countable resources. The remainder must be equal to or less than the $2,000 single resource standard.

3. Assessments Conducted At Application

Spousal Resources Allowance is assessed with each new application. This includes an individual who has a break in aid and a new application is required. Refer to Section M403 to determine when a new application is required after denial of Closure. Clients are assessed as individuals after the first year of eligibility.

4. Assessments May Be Conducted Without Applications

Assessments may be conducted upon request when there is no accompanying Medicaid application. Couples have the right to receive an assessment to determine countable resources in relation to the Medicaid resource standard.

5. Action On Assessments For Applications Must Be Taken Within 45 Days

6. Resources Of Institutionalized Spouse Must Be Transferred To Community Spouse

Countable resources of an institutionalized spouse must be transferred to a community spouse once eligibility has been established. The resources must be transferred before the first scheduled periodic review.

The purpose of this transfer is to assist community spouses in meeting their needs in the community.

The conversation about transferring resources should be documented in the case record.

7. Institutionalized Spouse Must Be Within Individual Resource Standard

At periodic review, only the client’s resources are reviewed. These resources must be within the $2,000 individual resource limit.

Defining Requirement: 20 CFR 416, Subpart L

42 CFR 435, Subpart G

Current Policy Effective Date: July 1, 2007

Date Last Reviewed: May 31, 2007

Previous Policy:

POL M807: DETERMINING TREATMENT OF RESOURCES

1. Exempts Certain Resources

Reference Medicaid Table 8 for information concerning exempt resources.

2. Resource Windows Capture Certain Information

Resource windows capture the following:

Liquid resources, which are readily available and easily converted to cash. Examples are checking, savings, and CDs. Other resources, which are available but not easily converted to cash. Examples are homes, contracts, land, real property, life insurance, boats, and campers. Vehicles, including automobiles and motorcycles.

Reference the linked table for a list of resources and their corresponding treatment.

Defining Requirement: 20 CFR 416, Subpart L

42 CFR 435, Subpart G

Income from financially-responsible household members is counted to determine an individual's eligibility. The individual's countable income must be calculated using actual income already received and anticipated income that can reasonably be expected during the month the application is submitted. Eligibility for Medicaid is determined by comparing the individual’s calculated income against the maximum income standards.

This section includes:

The rules for deciding what amount of a client's income (or income of a client's spouse, parents, or sponsor) must be counted to decide eligibility for the client.

An explanation what income is countable, what is exempt, and what income disregards or deductions are allowed.

A description of how to treat self-employment income.

The rules for calculating patient contribution.

Current Policy Effective Date: February 1, 2021

Date Last Reviewed: March 25, 2022

Previous Policy: September 1, 2016

POL M901: COUNTING INCOME

1. Applicants Must Report Total Available Gross Income

Applicants must report each source of available gross income.

An applicant’s income is considered available when it meets any of the following criteria:

Income is accessible to applicant. Income is received by applicant. Income is credited to applicant’s account. Income is set aside for applicant’s use.

2. Income Must Be Categorized

Income must be categorized as earned, unearned, exempt or nonexempt. Refer to Medicaid Table 2 for information on how to count income.

3. Income Carried Into Next Month Must Be Counted As A Resource

Income must not be counted as a resource in the same month it is counted as income.

4. Garnished Income Must Be Counted

Garnished income is defined as income involuntarily assigned to pay a debt.

5. Income From SSI Benefits Must Not Be Counted

Income from SSI benefits must not be counted as income for any Medicaid program.

6. Self-Employment Income Must Be Pro-Rated

Income meeting any of the following conditions must be pro-rated or averaged:

Income from self-employment. Income from employment on a contractual basis. Income received intermittently on a quarterly, semi-annual or annual basis during the time period covered by the income.

Refer to Section M902 for information on the treatment of self-employment income.

7. Income Available To Any Member Of Assistance Unit Must Be Counted

Applicants must take all necessary steps to obtain and report income available to any member of the assistance unit. Income from employment, annuities, pensions, retirement, and disability benefits must be included, unless good cause can be shown for not doing so.

These requirements may be waived if an applicant can show good cause for not reporting on these sources of income.

Refer to Medicaid Table 2 to determine how different types of income are counted.

8. Family And Children's Programs Countable Income Is Based On Modified Adjusted Gross Income (MAGI)

9. Income Of Spouse Is Available To Other Spouse For Family And Children’s Programs

10. Parent’s Income May Be Available To Children For Family And Children’s Programs

Income available to the parent of applicants must be counted to determine whether children are eligible for benefits.

Parent’s income must not be counted if any of the following conditions are met:

Child is in DFS custody. Child is married.

11. Children’s Income May Be Available To Parents For Family And Children’s Programs

12. Non-Relative’s Income Must Not Be Counted

Income of non-relatives living in the household must not be counted for Family and Children’s, SSI, or Aged, Blind, or Disabled Programs.

13. Income Of Spouse May Be Available To Other Spouse For SSI Or Aged, Blind And Disabled Programs

Spousal income is available to the other spouse when they live in the same household for the following programs:

QMB. SLMB #1 and #2. SSI – Related Programs.

Spousal income is unavailable to the other spouse for the following programs:

LSC. Long Term Care or Developmentally Disabled HCBS waiver. Hospice. Employed Individuals with Disabilities. IHC.

14. Parent’s Income May Be Available To Children For SSI Or Aged, Blind Or Disabled Programs

Parent’s income is available to a child(ren) for first month of institutionalization when either of the following conditions are met:

Parent and child lived in the same household before entering an institution. Child is applying for IHC, Hospice, LSC or SSI-related programs.

Parent’s income is not available to a child(ren) when either of the following conditions are met:

Child is disabled and receives SSI benefits while in an institution. Child is eligible for assistance under the DD HCBS waiver program. Child is eligible for assistance under the Children's Mental Health Waiver. Child is eligible for assistance under the Employed Individuals with Disabilities program.

15. Children’s Income May Impact Parents For SSI And Aged, Blind Or Disabled Programs

Income of an ineligible child(ren) is not available to parents. However, the dependent deduction must be reduced if the child(ren) has income. Refer to Medicaid Table 1A for dependent deductions.

16. Support Payments May Not Be Counted For SSI And Aged, Blind Or Disabled Programs

Income of an ineligible spouse, an ineligible parent, or an ineligible child used to make support payments must be excluded from countable income when:

Under a court order. OR Enforced in compliance with a State agreement under Title IV-D.

Income: 20 CFR 416. Subpart K

Defining Group: 42 CFR 435, Subpart G

45 CFR 233.10 – 233.38

Social Security Act § 19

SSI Income Is Not Countable.

Gross Income Is Defined As Income Before Taxes And Deductions.

Parent includes step-parent or adoptive parent.

Current Policy Effective Date: March 1, 2026

Date Last Reviewed: March 1, 2026

Previous Policy: December 1, 2015

POL M902: TREATMENT OF SELF-EMPLOYMENT INCOME

1. Applicants Must Report Gross Self-Employment Income

2. MAGI Programs Use The Adjusted Gross Income If There Is Not A Change In Income From Previous Year.

If current self-employment income is the same as the previous year, use the Adjusted Gross Income (AGI) on the previous year tax return plus:

Foreign Income excluded from AGI (line 37 or IRS Form 1040, line 4 on IRS Form 1040EZ, or line 21 of IRS Form 1040A) Nontaxable Social Security benefits (line 20a on IRS Form 1040) Tax-exempt interest received or accrues during the tax year (line 8b on IRS Form 1040)

3. Actual Business Expenses That May Be Deducted From Gross Self-Employment Income For MAGI Programs.

If self-employment income amount is different from the previous year or there is a change in the business source, a ledger or profit/loss statement can be used. Deduct from self-employment income the following business expenses:

Rent and utilities. Storage and warehousing charges. Upkeep of premises used for business. Depreciation. Advertising. Legal and Professional Fees. Interest on loans from your business (including mortgage interest paid to banks). Machinery repairs and maintenance. Wages and salaries paid to employees of business. Employees must be people that are not the applicant or other members of the assistance unit. Feed, stock, raw material, seed, plants and fertilizer. Taxes and insurance premiums paid on income-producing property. Rental payments on income-producing equipment. Privilege taxes such as licensing fees, gross receipts, and general excise taxes. Cost of merchandise and supplies. Transportation costs required to perform services or deliver goods that are related to the business. Other expenses incurred exclusively for the function of the business. Travel, meals, and entertainment - Expenses for lodging and transportation connected with overnight travel, if they are directly related to or associated with the active conduct of the trade or business. Do not allow expenses paid or incurred for a facility (such as a yacht or hunting lodge, etc.) used for any activity usually considered entertainment, amusement, or recreation. Do not deduct amounts paid or incurred for membership dues in any club organized for business, pleasure, recreation or other social purpose. This includes country clubs, golf, and athletic clubs, airline and hotel clubs.

4. Actual Business Expenses That May Be Deducted From Gross Self-Employment Income For Aged, Blind or Disabled, and Medicare Savings Programs.

Deduct from self-employment income the following business expenses:

Rent and utilities. Storage and warehousing charges. Upkeep of premises used for business. Machinery repairs. Wages and salaries paid to employees of business. Employees must be people that are not the applicant or other members of the assistance unit. Feed, stock, raw material, seed, plants and fertilizer. Taxes and insurance premiums paid on income-producing property. Rental payments on income-producing equipment. Privilege taxes such as licensing fees, gross receipts, and general excise taxes. Cost of merchandise and supplies. Transportation costs required to perform services or deliver goods that are related to the business. Other expenses incurred exclusively for the function of the business. Travel, meals, and entertainment - Expenses for lodging and transportation connected with overnight travel, if they are directly related to or associated with the active conduct of the trade or business. Do not allow expenses paid or incurred for a facility (such as a yacht or hunting lodge, etc.) used for any activity usually considered entertainment, amusement, or recreation. Do not deduct amounts paid or incurred for membership dues in any club organized for business, pleasure, recreation or other social purpose. This includes country clubs, golf, and athletic clubs, airline and hotel clubs.

Deduct out of pocket expenses for meals, toys and materials for child-care providers.

Do not deduct the following as business expenses:

Payments on the principal of the purchase price of income-producing real estate and capital resources, Examples of capital resources are equipment, machinery and other durable goods. Expenses and net losses from previous periods. Federal, state, and local income taxes. Money set aside for retirement purposes. Money set aside for other work-related personal expenses. Examples of other work related expenses are transportation to and from work, or entertainment expenses. Repayment on the principal of a bank loan. Depreciation on any equipment of resource used by the business. Penalties and fines related to the business. Charitable contributions made by the business.

5. Business Expenses Are Deductible When They Are Billed

Deduct allowable business expenses when they are billed or become due.

6. Self-Employment Income May Be Annualized

Annualize self-employment income when the following conditions are met:

Income is received over a short period of time but is intended to meet the financial needs of the assistance unit over the course of a year. Income is received on a monthly basis but represents annual income. Income is received from involvement in a business for less than a year but has been received for long enough to be able to average the income. In this case, income must also be indicative of future months.

7. Self-Employment Income May Be Averaged

Average self-employment income when the following conditions are met:

Income is intended to meet the financial needs of the assistance unit for a portion of the year and is indicative of the future. Income is received from involvement in a business that has not been in existence for long enough to provide sufficient information to annualize the income. In this case, income must also be indicative of future circumstances. Income substantially increases or decreases over the course of a year.

8. Self-Employment Income May Be Calculated on Monthly Basis

Allow applicant to anticipate self-employment income on a month-to-month basis rather than over the period of time covered by the income when this is advantageous to the assistance unit.

Re-calculate self-employment income when the most advantageous method is determined.

Defining Requirement: 20 CFR 416 - 1110

Self-employment income is defined as earning one's own living directly from one's own profession or business rather than earning a salary or commission from another.

Income related to an 'S Corporation' should be calculated in the same manner as self-employment income.

Current Policy Effective Date: August 1, 2008

Date Last Reviewed: July 29, 2008

Previous Policy:

POL M903: DETERMINING BEST ESTIMATES

Aged, Blind and Disabled Programs

1. Income May Need To Be Estimated

Complete a best estimate of prospective gross countable income when an applicant’s income is irregular. Use the applicant’s individual circumstances to determine the best approach for anticipating prospective gross countable income and determining the best estimate.

2. Best Estimates Include Actual and Estimated Income

Best estimates are determined by:

Counting actual income received during month of application. AND/OR Using the best estimate of any income the applicant expects to receive.

3. Second Month Income Estimate May Be Zero

The second and subsequent benefit month income estimates will be zero when both the following are true:

Applicant’s income ceases during the month of application for benefits. Applicant does not expect to receive additional income.

4. Existing Income History Must Be Used

When possible, use an applicant’s income history to determine the best estimate of future income.

Verified income history of at least 30 days, but not exceeding 60 days, may be used.

5. Best Estimates Must Be Reviewed

The best estimate of a client’s income must be reviewed when any of the following occur:

Client experiences a change in circumstances. Client reports a change in circumstances. Client is scheduled for a periodic review/recertification.

Income: 20 CFR 416, Subpart K

Defining Group: 42 CFR 435 Subpart G

Best Estimate is defined as a Benefit Specialist's best determination based on knowledge of past, current, and future case circumstances, which accurately reflects all facts known to the benefit specialist at the time.

Determining Best Estimate of Applicant’s Gross Countable Income

1. Determine earned and unearned income.

2. Verify past income with pay stubs when applicant has pay stubs covering at least a 30-day history of income.

2A. Do not exceed 60 days history.

3. Require an employer’s statement or other verification of past income when applicant does not have at least a 30-day history of income or if the history is not indicative of the future.

4. Estimate tips, commissions, overtime, differential pay, or other source of income when applicant’s employment indicates that applicant may receive income from one of these sources.

5. Count self-employment income representing the months for which applicant is applying for benefits.

5A. Deduct allowable business expenses from self-employment income.

5B. Refer to Section M902 for information on self-employment income and deductible business expenses.

6. Count irregular income representing months for which applicant is applying for benefits.

7. Prorate or average income from self-employment, contractual employment or intermittent income unless income is not indicative of future months.

7A. Examples of intermittent income are income received quarterly, semi-annually, or annually.

8. Count number of paychecks normally received by applicant in cases where a problem with payroll or mail causes the applicant to receive fewer or additional paychecks.

9. Document in applicant’s case record method used to determine best estimate.

10. Document rationale for choosing the method.

Current Policy Effective Date: July 1, 2006

Date Last Reviewed: April 23, 2007

Previous Policy:

POL M904: BENEFIT LEVELS

1. Applicant’s Maximum Benefit Level Determined Using Poverty Levels

The appropriate maximum income standard and/or maximum benefit level for all coverage groups must be determined by using the Maximum Income Standards Table (Reference Medicaid Table 1 ).

Defining Requirement: 42 CFR 435, Subpart A

Current Policy Effective Date: January 1, 2019

Date Last Reviewed: August 22, 2019

Previous Policy: May 1, 2017

POL M905: INCOME DISREGARDS/DEDUCTIONS

1. Allow A 5% FPL Income Disregard For MAGI Programs When It Would Make A Difference In Eligibility.

2. Allow Tax Deductible Adjustments To Income For MAGI Programs

Deductions and adjustments include:

Alimony paid to someone else for agreements finalized on or before December 31, 2018. Student loan interest paid Certain educator expenses Most contributions to individual retirement arrangements (IRAs) Penalties on the early withdrawal of savings Certain tuition and fees Health savings account contributions Certain business expenses not included in net income Net operating loss Other adjustments to gross income on IRS 1040 form lines 23-35 Moving expenses for Active Duty Military members that are ordered to move or change duty stations.

3. Do Not Include Credits And Deductions Listed On Page 2 Of IRS Form 1040 For MAGI Programs:

The standard deduction Itemized deductions detailed in Schedule A Child tax credit

4. Some Business Expenses May Be Deducted From Gross Self-Employment Income

Refer to M902 for Treatment of Self-Employment Income.

5. Allow The Following Deductions For The Medicare Savings Programs And Supplement Security Income (SSI) Program When Calculating Income:

$20 unearned income deduction per assistance unit $65 plus one-half of the remaining earned income is deducted for each working individual. Blind or impairment related work deduction for items or services directly related to assuring the blind/disabled individual can work. Dependent deduction for each ineligible child. Refer to Medicaid Table 1A , for the dependent deduction. Support payment deduction when there is a court order or state agreement under Title IV-D, and the payment is made by the ineligible spouse, ineligible parent, or ineligible child. Deduct either: The amount specified in the court order or agreement. The actual amount paid when less.

OR

The actual amount paid when more if the excess amount is for averages.

Defining Requirement: 20 CFR 416, Subpart K

42 CFR 435, Subpart

Deductions should not be entered into WES for MAGI programs if they do not make a difference in eligibility.

Current Policy Effective Date: July 1, 2023

Date Last Reviewed: October 19, 2023

Previous Policy: December 1, 2022

POL M906: COMPLETING MEDICAL ASSISTANCE COMPUTATIONS

1. Employed Individuals With Disabilities (EID) Premium

The EID program requires a monthly premium to be paid by the client based on gross monthly income. The premium must be recalculated when there is an increase or decrease in income.

Refer to Section M1003 for information on how to calculate the premium.

2. Certain Clients May Pay Patient Contribution Toward Cost Of Care

A client in ICF-ID (Wyoming Life Resource Center), Geriatric Hall at the State Hospital in Evanston, Inpatient Hospital, or Nursing Home/Swing Bed must pay a patient contribution toward their cost of care.

The following programs do not require a patient contribution:

Acquired Brain Injury Waiver Comprehensive and Support Waivers Children’s Mental Health Waiver Hospice Care Community Choices Home & Community Based Waivers

3. Patient Contribution May Be Required For Partial Month

ICF-ID (Wyoming Life Resource Center), Geriatric Hall at the State Hospital in Evanston, Inpatient Hospital, or Nursing Home/Swing Bed client must private pay toward their cost of care when a partial month penalty is imposed from an uncompensated resource transfer. Refer to Medicaid Table 9 for additional information.

4. Clients May Pay Prorated Patient Contribution

A client may pay a prorated amount toward the cost of care, based on the number of days in the facility, when any of the following occur:

Client enters or is discharged from a facility after the first of the month. Medicare is no longer paying room and board in full and the facility has notified you of the end date. Client passes away.

5. Clients With A Long Term Care (LTC) Insurance Policy May Pay A Reduced Patient Contribution

An LTC Insurance policy that pays directly to the facility, provider or the Wyoming Department of Health (WDH) reduces the amount the client pays toward their cost of care.

6. Clients May Not Pay An Initial Patient Contribution

Clients, who are already Medicaid eligible when they enter the nursing home, are not required to pay a patient contribution for the first 30 days in a facility. After 30 days pass, a patient contribution is required for the next full month.

Clients who are eligible for the Medicare Savings program are required to pay a patient contribution beginning with the month of entry into a nursing home.

7. Child Support May Be Deducted

The actual court ordered liability for child support may be deducted, against gross countable income, when calculating the patient contribution.

8. Deduction For Dependent Child

Dependent deduction may be allowed, against gross countable income, for each dependent child. Refer to Medicaid Table 1A for the dependent deduction amount.

9. Spousal Maintenance Allowance May Be Deducted

Spousal maintenance allowance may be deducted, against gross countable income, when there is a community spouse and his or her spouse is Medicaid eligible in a nursing home. Refer to Medicaid Table 1A for spousal maintenance allowance amount.

Community spouses should be informed the receipt of the spousal maintenance allowance could cause the loss of SSI, Medicaid, and/or MSP benefits.

Clients may refuse to make an allowance available or allow a partial allowance by writing a statement.

10. Spousal Maintenance Allowance May Increase

A spousal maintenance allowance may increase if the community spouse is found to have exceptional circumstances resulting in extreme financial duress.

11. Medical Expenses May Be Deducted From Patient Contribution

Medical expenses not covered by Medicaid, Medicare, private insurance, or a third party may be deducted, against gross countable income, when calculating the patient contribution.

Do not allow a deduction when a transfer penalty has been assessed on the case.

Medical expenses may be deducted from income, when calculating the patient contribution, until the medical expense is paid in full.

12. Medical Care Items Included In Daily Rates Must Not Be Deducted

Medical care items provided by an institution and included in the daily rate must be excluded from deductions. These include:

Wheelchairs, ice bags, bed rails, canes, crutches, walkers, or repair/replacement of such items Influenza or pneumococcal vaccines Oxygen or surgical supplies Over-the-counter items

13. Medicare Premium May Be Deducted From Patient Contribution

Allow a medical deduction, for Medicare premium(s) Part C and Part D when calculating the patient contribution. See Table 5B for documentation required to allow these deductions.

14. Health Insurance Premiums May Be Deducted From Patient Contribution

Allow a deduction, against gross countable income, for a health insurance premium and increase the deduction in any month the premium changes, when calculating the patient contribution.

Allow a deduction when the client has a single health insurance policy and pays a premium. Allow a deduction for the portion of the premium, applicable to the client, when there is a joint health insurance policy. Allow a deduction for the portion of the premium, applicable to the client, when the spouse pays the health insurance premium.

15. Home Maintenance Expense May Be Deducted From Patient Contribution

Allow a monthly deduction of $150, against gross countable income, to cover home maintenance for an individual or couple who are temporarily in an institution for six months or less.

Clients must provide a written statement from a physician to verify the temporary stay.

Expenses may not be deducted if the client has a community spouse.

16. Guardianship Costs May Be Deducted From Patient Contribution

Allow a deduction of $500, against gross countable income, to help with the cost of establishing a guardianship. An additional $75 per month may be deducted for guardianship fees.

17. Personal Needs Allowance Of $50 May Be Deducted Monthly

18. Wyoming Life Resource Center Individuals May Be Allowed A Working Deduction

Allow a deduction of $65 plus one-half of the remaining earned income, not to exceed $300, against gross countable income, for each working individual in the Wyoming Life Resource Center.

19. Income Trust Distributions For Nursing Home

For income trusts established on or after October 17, 2017

Allow the following distributions from an Income Trust:

Monthly distribution for each dependent child. Refer to Medicaid Table 1A . Monthly distribution for Trustee Fees not to exceed $20 per month. Yearly distribution for Income Tax, when taxes are required by law and owed to the Internal Revenue Service (IRS). One-time distribution of no more than $100 for actual verified expenses related to the establishment of the Income Trust. Distribution of $500 to help with the cost of establishing a guardianship. Monthly distribution of $75 for guardianship fees. Monthly spousal maintenance allowance. Figure by taking the spousal maintenance allowance minus the income of the community spouse. Refer to Medicaid Table 1A (F). The balance is the amount that can be distributed to the community spouse from the trust.

For income trusts established after September 1, 1998:

Allow all deductions listed above. In addition, allow the following distributions from the Income Trust: Administrative fees of the trust, not to exceed $20 per month. Income tax owed on the income within the trust. Attorney fees the trust is obligated to pay.

20. Income Trust Distributions For HCBS Waivers

For Income Trusts set up on or after October 17, 2017:

Allow the following distributions from an Income Trust:

Monthly distribution to the client, of the maximum income standard to the client. Refer to Medicaid Table 1A . Monthly distribution for each dependent child. Refer to Medicaid Table 1A . Monthly distribution for Trustee Fees, not to exceed $20 per month. Yearly distribution for Income Tax, when taxes are required by law and owed to the Internal Revenue Service (IRS). One-time distribution of no more than $100 for actual verified expenses related to the establishment of the Income Trust. Distribution of $500 to help with the cost of establishing a guardianship. Monthly distribution of $75 for guardianship fees. Monthly spousal maintenance allowance. Figure by taking the spousal maintenance allowance minus the income of the community spouse. Refer to Medicaid Table 1A (F). The balance is the amount that can be distributed to the community spouse from the trust.

The following may be distributed from an Income Trust established before October 17, 2018:

A monthly payment of the maximum income standard. Refer to Medicaid Table 1A (A). Administrative fees of the trust, not to exceed $20 per month. Income tax owed by the trust. Attorney fees the trust is obligated to pay. Spousal maintenance allowance. Figure by taking the spousal maintenance allowance minus the income of the community spouse. Refer to Medicaid Table 1A (F). The balance is the amount that can be distributed to the community spouse from the trust. Monthly distribution for each dependent child. Refer to Medicaid Table 1A . Distribution of $500 to help with the cost of establishing a guardianship. Monthly distribution of $75 for guardianship fees.

21 . Income From A Spouse Not Living In The Household May Not Be Included

If an applicant is separated from their spouse and the spouse does not live in the household, do not include the spouse in the household or request income verification for the spouse beginning the first of the month after separation.

Defining Requirement: 20 CFR 416, Subpart K

42 CFR Subpart I

Calculating Income And Converting To Monthly Amount

1. Paid weekly - Multiply gross income by 4.3 for monthly amount.

2. Paid bi-weekly - Multiply gross income by 2.15 for monthly amount.

3. Paid semi-monthly - Multiply gross income by 2 for monthly amount.

Allow applicants to anticipate income on a month-to-month basis rather than using the 4.3, 2.15, or 2 conversions, when advantageous to the assistance unit.

Determining Patient Contribution

1. Prorate the patient contribution when a client resides in nursing home for a partial month.

Example:

Prorating Income

Client enters nursing home on 3/19.

Monthly income is $1307.90.

$1307.90 - $304.90 (allowable deductions) divided by 31 days = $32.25 x 9 days = $291.15 patient contribution.

2. Calculate the patient contribution when an individual has a long term care insurance policy in the following manner:

Example:

Long Term Care Insurance Policy

Example 1

STEP 1

Nursing Home Daily Rate: $143.10

Times # of days in month x 30

Total monthly Medicaid rate $4,293.00

LTC insurance payment $140.00

Times # of days in month x 30

Total monthly LTC Insurance payment - $4,200.00

Subtract monthly Medicaid rate from the monthly LTC Insurance payment

Total Amount Owed to Facility $ 93.00

STEP 2

Clients Gross Income: $400.00

Minus Allowable deductions: - $ 50.00

Clients Countable income $ 350.00

STEP 3 Patient Contribution

Patient contribution is $93.00

The patient contribution will be whichever is less, the total amount owed to the facility or the client’s countable income after deductions.

Example 2

STEP 1 – Total Amount Owed to Facility

Nursing Home Daily Rate: $187.00

Times # of days in month x 31

Total monthly Medicaid rate $5,797.00

LTC insurance payment $125.00

Times # of days in month x 31

Total monthly LTC Insurance payment - $3,875.00

Subtract monthly Medicaid rate from the monthly LTC Insurance payment

Total Amount Owed to Facility $1,922.00

STEP 2 Client’s Countable Income

Clients Gross Income: $600.00

Allowable Deductions: - $ 50.00

Clients Countable Income $ 550.00

STEP 3 Patient Contribution

Patient contribution is $550.00

* The patient contribution will be whichever is less, the total amount owed to the facility or the client’s countable income after deductions.

This section will describe the eligibility requirements and the eligibility determination process for all Aged, Blind & Disabled coverage groups. The programs covered under this group are:

This section describes the eligibility requirements and the eligibility determination process for programs where the client would reside in an institution.

Current Policy Effective Date: June 1, 2022

Date Last Reviewed: April 29, 2022

Previous Policy : March 1, 2022

POL 1001A: DETERMINING ELIGIBILITY FOR NURSING HOME/SWING BED 1. Applicants Must Meet Basic Eligibility Factors Refer to Section M600 for a description of all basic eligibility factors. 2 Applicants Must Meet Medical Necessity Requirement Applicants must meet medical necessity. Medical necessity is verified, at initial application or when the client is moving to the Nursing Home program from another coverage group, through the LT101 assessment if the client is 19 years of age or older or the LT104 assessment if the client is younger than 19 years of age, on the Provider Web Portal and will show as eligible on the placement summary. Require a new LT101 or LT104, when the referral date on the assessment is over 365 days. Once medical necessity is verified and the referral date on the assessment is within 365 days, authorize benefits beginning with the first month of eligibility.

3. Applicants Must Be Aged, Blind Or Disabled

Applicants must meet one of the following factors:

Aged – 65 or older.

Blind – legally blind based on Social Security standards.

Disabled – person who receives disability benefits from SSA or is determined disabled by WDH.

4. Applicants Must Meet 30-Day Requirement

Applicants must meet a 30-day requirement by any of the following:

Remain in an institution for 30 consecutive days. Not completing the 30-day requirement due to death. Verified as SSI eligible. Receive Home and Community Based Waiver Services immediately prior to entering the nursing home.

5. SSI Eligibles Do Not Need To Submit Application

If client becomes ineligible for SSI, an application will be required to determine continued eligibility under another coverage group.

6. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable. Provide an Income Trust Packet when the countable income is above the maximum income standard.

7. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Section M801 to determine if resource is countable.

8. Some Services Withheld For Resource Transfers

Resources cannot be transferred for less than fair market value during the look-back period, prior to application or when a client is receiving benefits.

If clients transfer resources for less than fair market value but meet all other eligibility factors, a penalty period must be imposed. The following will occur during the penalty period:

Payment for nursing home facility services must be withheld.

Other Medicaid services must be authorized.

Clients must receive notification that they are Medicaid eligible even though nursing facility services will not be covered for the penalty period.

Refer to Section M803 to determine if a resource transfer is exempt and Section M804 for information on related penalties.

9. Benefits Begin First Month Of Eligibility

Once applicants meet the 30-day requirement of institutionalization, benefits must be authorized beginning with the first month of eligibility.

10. Applicants May Receive Retroactive Medicaid

Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.

Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made. Medical bills may be paid for this period when eligible.

11. Clients Pay Patient Contribution

Client is required to pay a contribution toward the cost of care.

Require the client to pay toward the cost of care when a partial month penalty is imposed due to a transfer of a resource.

Refer to Section M906 for details on calculating the patient contribution.

12. Clients May Pay Prorated Amount

Prorate the patient contribution when the client does not reside in a nursing home for a full month or Medicare pays for the cost of care. Refer to Section M906 for details on calculating the patient contribution.

13. Clients May Not Pay Patient Contribution First Month

Nursing home clients who are Medicaid eligible when they enter the facility, do not pay a patient contribution during their first month of eligibility. Clients must pay a patient contribution the first full month following 30 days of nursing home residency.

14. Clients Pay No Patient Contribution When Transitioning To HCBS

15. Clients In Nursing Home May Continue Receiving Hospice

Clients who elect Hospice while in a nursing home should remain on the Nursing Home program and continue to pay a patient contribution to the nursing home. Refer to M1001C for Hospice specific information.

If the client elects Hospice and is authorized for the Hospice program prior to entering the nursing home, the client will not have a patient contribution.

16. Applicants May Have Eligibility For 12 Continuous Months

The eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for children under the age of 19.

17. Clients must be reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases

18. Clients May Lose Benefits

The case will close when any of the following occur:

Client leaves nursing home.

Client does not complete review.

Client dies.

Client determined no longer eligible.

Defining Group: 42CFR 435 Subpart F

42CFR 435.132

Income: 42CFR 435 Subpart K

Resources: 42CFR 435 Subpart L

Accessing LT101 To Determine Medical Necessity

1. Log into the Provider Web Portal through the following link:

https://wyequalitycare.acs-inc.com/wy/general/home.do ; OR

1A. Log into the Provider Web Portal through ECOM.

Click the LT101 tab from ECOM (the Provider Welcome page will open) Click on the Provider Tab Click on Returning Provider or New Providers when you haven't registered through the Web Portal

2. Enter your User ID and Password

3. Click on the "Log In" button (The Wyoming Medicaid Home page will open)

4. Select the LT101 Inquiry link on the left hand side of the Wyoming Medicaid Home Page.

5. Conduct the client search by entering one of the following:

Enter Wyoming Medicaid ID#, or Combination of Name, Date of Birth and Gender; or Combination of Name and Social Security Number; or Combination of Date of Birth and Social Security Number.

6. Click on Submit. A message may appear that there are not LT101 records for the Wyoming Medicaid client.

7. Click on the button corresponding to the Placement Summary to view the LT101 assessment, this verifies medical necessity

8. Click the "Submit" button (the Assessment of Medical Necessity for Long Term Care web page will open).

9. Print this screen as verification of medical necessity and upload to the Wyoming Eligibility System (WES).

Closing Cases

1. Finalize eligibility and close benefits in WES when the applicant is no longer eligible.

2. Allow 15-day closure notice when an adverse action has occurred.

Current Policy Effective Date: January 1, 2022

Date Last Reviewed:

Previous Policy: November 1, 2015

POL M1001B: DETERMINING ELIGIBILITY FOR INPAT-PSYCH (GERIATRIC HALL AT THE STATE HOSPITAL IN EVANSTON)

1. Applicants Must Meet Basic Eligibility

Refer to Section M600 for a description of all basic eligibility factors.

2. Applicants Must Be Age 65 Or Older

3. SSI Eligibles Do Not Need To Submit Application

If SSI is lost, an application will be required to redetermine eligibility.

4. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable.

Use only the applicant’s income when determining if income requirements are met.

5. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Section M801 to determine if resources are countable.

6. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

7. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client does not complete review. Client dies. Client determined no longer eligible.

Defining Group: Social Security Act § 1902(a)(10)(A)(ii)(xv)

Income: 42 CFR 435 Subpart K

Resources: 42 CFR 435 Subpart L

Applicants Do Not Have to Meet Medical Necessity.

Applicants Do Not Have to Meet 30 Consecutive Days of Institutionalization Requirement.

Applicants Do Not Have to Make Patient Contributions.

Closing Cases

1. Finalize eligibility and close benefits in WES when the the applicant is no longer eligible.

2. Allow 15-day closure notice when an adverse action has occurred

Current Policy Effective Date: June 1, 2022

Date Last Reviewed: April 29, 2022

Previous Policy: February 1, 2021

POL 1001C: DETERMINING ELIGIBILITY FOR HOSPICE CARE

1. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors.

2. Applicants Must Elect Hospice Care And Have Physician Verification

Applicants seeking hospice care must have a physician’s statement with a medical prognosis indicating a life expectancy of six months or less and complete an Election Statement with a Hospice provider.

3. Applicants Must Meet 30-Day Requirement

Applicants must meet a 30-day requirement by any of the following:

Completing 30 days of institutionalization immediately prior to the Hospice election. Completing an election statement 30 days prior to authorization of benefits with a particular Hospice. Not completing the 30-day requirement because of death. Verified as SSI eligible. Receive Home and Community Based Waiver Services immediately prior to Hospice election.

4. Benefits Begin Month Of Hospice Selection

Authorize benefits beginning the first of the month of the Hospice election statement once the applicant meets the 30-day requirement.

5. SSI Eligibles Do Not Need To Submit Application

Require an application when the client loses their SSI to redetermine continued eligibility for the Hospice program.

6. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable.

7. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see asset standards. Refer to Section M801 to determine if resources are countable.

8. Clients May Continue Receiving Hospice If Entering Nursing Home

Clients on the Hospice program who enter a nursing home should remain on the Hospice program and will not have a patient contribution. The hospice provider will bill room and board directly to the fiscal agent.

Hospice benefits must continue to be authorized if clients continue to have a physician’s medical prognosis of six months or less to live. If clients do not have this medical prognosis any longer, screen eligibility under another Medicaid coverage group.

9. Nursing Home Clients Who Need Hospice Care

If a nursing home client stays in the nursing home to receive hospice services, the client will remain on the Nursing Home program and continue to pay the patient contribution to the nursing home .

If a nursing home client leaves the nursing home and enters a hospice facility or receives hospice services at home, switch the client to the Hospice program and pro-rate the patient contribution for any partial month in the nursing home. After this pro-rated payment, the hospice client is no longer required to pay a patient contribution while receiving hospice services outside of the nursing home .

10. Clients May Receive Retroactive Medicaid

Applicants may receive Medicaid benefits if they incurred medical bills during any of the three months prior to application.

Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.

11. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

12. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client elects to not receive hospice any longer. Client does not complete review. Client dies. Client determined no longer eligible.

Defining Group: 20CFR 435 Subpart F

Social Security Act § 1902(a)(10)(A)(ii)(vii)

Income: 42CFR 435 Subpart K

Resources: 42CFR 435 Subpart L

Timely Determination: 42CFR 435.911

Applicants Do Not Need to Meet Aged, Blind, & Disabled Factor.

Resource Transfer Provisions Do Not Apply.

Clients Pay No Patient Contribution.

Closing Cases

1. Finalize eligibility and close benefits in the WES when the applicant is no longer eligible.

2. Allow 15-day closure notice when an adverse action has occurred.

Current Policy Effective Date: January 1, 2022

Date Last Reviewed:

Previous Policy: November 1, 2015

POL M1001D: DETERMINING ELIGIBILITY FOR INPATIENT HOSPITAL CARE

1. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors.

2. Applicants Must Be Aged, Blind Or Disabled

Applicants must meet one of the following factors

Aged – 65 or older. Blind – legally blind based on Social Security standards. Disabled – person who receives disability benefits from SSA or is determined disabled by WDH.

3. Applicants Must Meet 30-Day Requirement

Applicants must meet a 30-day requirement by any of the following:

Remain in a medical institution for 30 consecutive days. Not completing the 30-day requirement due to death. Verified as SSI eligible.

4. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable.

5. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Medicaid Table 8 to determine if assets are countable.

6. Applicants May Receive Retroactive Medicaid

Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.

Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.

7. Benefits Begin First Of Month After Meeting 30-Day Requirement

Once applicants meet the 30-day requirement, benefits must be authorized back to the first day of the month in which the institutionalization began, if eligible.

8. Clients Pay Patient Contribution

Client is required to pay a contribution toward the cost of care.

Refer to Section M906 for details on calculating the patient contribution.

9. Clients May Pay Prorated Amount

Prorate the patient contribution when the client does not reside in a hospital for a full month or Medicare pays for the cost of care. Refer to Section M906 for details on calculating the patient contribution.

10. Applicants May Have Eligibility For 12 Continuous Months

Eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for children under the age of 19.

11. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

12. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client leaves hospital. Client dies. Client does not complete review. Client determined no longer eligible.

Defining Group: 42 CFR 435 Subpart F

42 CFR 435.236

Income: 42 CFR 435 Subpart K

Resources: 42 CFR 435 Subpart L

Resource Transfer Provisions Do Not Apply.

Closing Cases

1. Finalize eligibility and close benefits in WES when the applicant is no longer eligible.

2. Allow 15-day closure notice when an adverse action has occurred.

Current Policy Effective Date: January 1, 2022

Date Last Reviewed:

Previous Policy: November 1, 2016

POL 1001E: DETERMINING ELIGIBILITY FOR ICF-ID (Wyoming Life Resource Center)

1. Applicants Must Meet Basic Eligibility Factors

Reference Section M600 for a description of all basic eligibility factors.

2. Applicants Must Meet Level of Care Requirement

Applicants must be approved for ICF/ID level of care as indicated on the LT-104.

3. Applicants Must Meet Disability Requirements

Applicants meeting the level of care requirement, as indicated on the LT-104, fulfill disability requirements.

4. SSI Eligibles Do Not Need to Submit Application

If SSI is lost, an application will be required to redetermine eligibility.

5. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable.

6. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Section M801 to determine which resources are counted.

7. Some Services Withheld for Nonexempt Resource Transfers

Resources cannot be transferred for less than fair market value during the look-back period prior to application or when a client is receiving benefits.

If a client transfers resources for less than fair market value, but meets all other eligibility factors, a penalty period must be imposed. During the penalty period:

Payment for Wyoming Life Resource Center services must be withheld. Other Medicaid services must be authorized.

Clients must receive notification that they are Medicaid eligible even though room and board will not be covered for the penalty period.

Refer to Section M803 to determine if a resource transfer is exempt.

8. Benefits Begin First Day of Month of Institutionalization

Applicants are not required to meet the 30-day stay.

9. Clients Pay Patient Contribution

Client is required to pay a contribution toward the cost of care.

Require the client to pay toward the cost of care when a partial month penalty is imposed from an uncompensated resource transfer.

Refer to Section M906 for details on calculating the patient contribution.

10. Clients May Pay Prorated Amount

If the client does not reside in the facility for a full month, they may pay a prorated amount based on the number of days they resided in the facility. Reference Section M906 for details on calculating the patient contribution.

11. Clients May Not Pay Patient Contribution First Month

Clients previously Medicaid eligible do not pay a patient contribution during their first month of eligibility. Clients must pay a patient contribution the first full month following 30 days of placement.

12. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

13. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client leaves Wyoming Life Resource Center. Client does not complete review. Client dies. Client determined no longer eligible.

Defining Group: 42CFR 435 Subpart F

42CFR 435.132

Income: 42CFR 435 Subpart K

Assets: 42CFR 435 Subpart L

SSI Eligibles Do Not Require an Application.

If SSI is Lost, an Application Will Be Required to Redetermine Eligibility.

Determining Countable Income

1. Refer to Section M901 for information on determining countable income.

Determining Countable Resources

1. Refer to Section M801 for information on determining countable resources.

Calculating Nonexempt Resource Transfer Penalty

1. Refer to Sections M803 and M804 for information on determining resources transfer penalties.

Reviewing Cases

1. Refer to Section M1403 for information on reviewing cases.

This section describes the eligibility requirements and the eligibility determination process for programs where the client is eligible for home and community based services.

Current Policy Effective Date: August 1, 2025

Date Last Reviewed:

Previous Policy: January 1, 2022

POL 1002A: DETERMINING ELIGIBILITY FOR COMMUNITY CHOICES HOME & COMMUNITY BASED WAIVER

1. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors.

2. Applicants Must Meet Medical Necessity Requirement

Applicants must meet medical necessity. Medical necessity is verified through an LT 101 and stored on the Medicaid Waiver system. Upload the Medicaid Activation Waiver Screen showing the applicant has received a funding opportunity and a Plan of Care has been approved. This verifies the applicant has met the medical necessity requirement.

3. Applicants Must Be Aged, Blind Or Disabled

Applicants must meet one of the following factors:

Age – 65 or older. Blind – legally blind based on Social Security standards. Disabled – person who receives disability benefits from SSA, or is determined disabled by WDH.

4. Applicants Must Be Age 19 Or Older

5. SSI Eligibles Do Not Need To Submit Application

If the client becomes ineligible for SSI, an application will be required to determine continued eligibility.

6. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard. Refer to Medicaid Table 1A for the income standards. Refer to Section M901 to determine if income is countable. Provide an Income Trust Packet when the countable income is above the maximum income standard.

7. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource standards. Refer to Medicaid Table 7 for the resource standards. Refer to Section M801 to determine if resources are countable.

8. Services Withheld For Resource Transfers

Resources cannot be transferred for less than fair market value during the look-back period prior to application or when clients are receiving benefits.

Refer to Section M803 for information on transferred resources and Section M804 for information on transfer penalties.

9. Clients Must Have Approved Plan Of Care

10. Benefits Begin First Day of Month Plan Of Care Is Approved

Benefits begin the first day of the month the plan of care is approved by WDH.

11. Clients May Enter Nursing Homes

Clients entering a nursing home and remaining for 30 days must have their coverage changed to Nursing Home Care. Refer to Section M1001A for additional eligibility information.

12. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

13. Clients May Lose Benefits

The case will close when any of the following occur:

Client is discharged from the the Community Choices Home & Community Based Waiver. Client does not complete a review. Client dies. Client determined no longer eligible.

Defining Age, Blind, Disabled: 42 CFR 435 Subpart F

Income: 42 CFR 435 Subpart K

Resources: 42 CFR 435 Subpart L

Defining Group: 42 CFR 435.217

Social Security Act §1902(a)(10)(A)(ii)

1. Clients Pay No Patient Contribution.

Clients do not pay a patient contribution. There will be a patient contribution after 30 days if a client transfers to a nursing home.

Accessing Waiver System To Determine Eligibility

1. Access the Medicaid Waiver System to determine status of the waiver process and verify the medical necessity requirement has been met.

1A. Log into Waiver System by Clicking on the "Medicaid Waiver System" tab in ECOM or access at https://waivers.health.wyo.gov .

1B. Enter your user name and password. Click on the "Log In" button.

1C. Review the Confidentially Agreement, Check the box indicating that you agree, and Click on the "Continue" button to proceed. This agreement must be completed the first time you log into the system and is required again every 45 days.

2. Complete assigned tasks for applicants who are in the Medicaid Waiver System and meet the eligibility requirements.

2A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you on what action needs to be completed.

2B. View , under Eligibility, a check mark by Review LT-101 verifies the Medical Necessity requirement has been met.

2C. The system will show Eligibility under Process, complete the determination:

2Ci) Click on Disability requirement has been met when the applicant or client is under 65, and has been determined disabled by SSA or WDH. (This field will only display when the applicant or client is under the age of 65.)

2Cii) Enter the Client ID # from WES.

2Ciii) Click on Has met the income and resource eligibility requirements.

2Civ) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

2D. The system will communicate the eligibility determination and place the individual on a waiting list.

2E. Pend the case in WES until a Plan Of Care is approved and a start date is provided through the Medicaid Waiver System.

2F. Send a Pending Notice in WES when the individual meets all eligibility requirements.

3. Complete assigned tasks for applicants who are in the Medicaid Waiver System and do not meet the eligibility requirements.

3A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you to complete the required actions.

3B. The system will show Eligibility under Process, complete the determination:

3Bi) Click on Disability requirement has not been met when the applicant or client is under age 65, and has not been determined disabled by SSA or WDH. (This field will only display when the applicant or client is under the age of 65.) OR

3Bii) Click on Disability requirement has been met when the applicant or client is under age 65, and has been determined disabled by SSA or WDH. (This field will only display when the applicant or client is under the age of 65.) AND

3BiiA) Click on Has been denied financial eligibility .

3Biii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

3C. The system will communicate the eligibility determination and notify the waiver program of the denial.

4. Complete a search for an existing waiver client who is being closed or an applicant who is on the waiting list who is being denied.

4A. Click on the "Search Cases" tab.

4B. Fill in any combination of information to find a client.

4C. Click on the "Search" button.

4D. Click on the "View" icon next to the client's name.

4E. Click on the drop down menu to select a reason for accessing this case and Click "Save."

4F. Enter closure or denial reason, the date the client was notified and the effective date of the closure or denial.

4G. Click "Close."

5. Receive notification from the Medicaid Waiver System when an applicant has a funding opportunity.

5A. Redetermine financial eligibility if 60 days has passed since initial application.

5B. Access the Medicaid Waiver System.

5C. View the Process, Funding Opportunity and Status, Confirm Financial, found under your assigned tasks.

5Ci) Click on Disability Requirement has been met. (This field will only display if the applicant or client is under the age of 65.)

5Cii) Click on Has met the income and resource eligibility requirements or

5Ciii) Click on Has been denied financial eligibility .

5Civ) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

5D. Notification will be sent from the Medicaid Waiver System with the approved Plan Of Care start date.

Authorizing Cases in WES

1. Complete updating resources and income in WES in the month of application and the first month of waiver eligibility forward to maximum benefit month.

Determining Continued Eligibility If Client Loses SSI

1. Require a DHCF-300 Disability Application from the client to determine continued eligibility.

Determining Eligibility For Applicant That Does Not Meet Waiver Eligibility

1. Screen the applicant to see if the individual meets eligibility under another Medicaid group.

2. Deny the application when not eligible.

Applications Received For Applicants Not In The Medicaid Waiver System

1. Email the Waiver Program Manager to determine if an application has been received.

2. Screen the Medicaid application for eligibility under another group when an application has not been received by the Waiver Program Manager.

Closing Cases

1. Finalize eligibility and close benefits in WES when the applicant is no longer eligible

2. Allow 15-day closure notice when an adverse action has occurred.

3. Access the Medicaid Waiver System to communicate the eligibility determination.

This section describes eligibility requirements and the eligibility determination process for the Comprehensive and Support Waivers.

Waivers are programs that waive certain restrictions of the Wyoming State Medicaid Plan to allow the state to fund services in a person’s local community. The goals of these services are to support individuals in their own community and to avoid the need for residential institutional care.

Current Policy Effective Date: August 1, 2025

Date Last Reviewed:

Previous Policy: January 1, 2022

POL M1002B1: DETERMINING ELIGIBILITY FOR COMPREHENSIVE AND SUPPORT WAIVERS

1. Applicants Must Meet Basic Eligibility

Refer to Section M600 for information on basic eligibility.

2. Applicants Must Meet Level Of Care Requirement

Applicants must be approved for ICF-MR level of care.

3. Applicants Meet Disability Requirements

Applicants meeting the level of care requirement fulfill disability requirement.

4. SSI Eligibles Do Not Need To Submit Applications

If SSI is lost, an application will be required to redetermine eligibility.

5. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable. Provide an Income Trust Packet when the countable income is above the maximum income standard.

6. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Section M801 to determine if resources are countable.

7. Some Services Withheld For Nonexempt Resource Transfers

Nonexempt resources cannot be transferred for less than fair market value during the look-back period prior to application or when clients are receiving benefits.

Refer to Section M803 to determine if a resource transfer is exempt and Section M804 for information on related penalties.

8. Applicants May Have Eligibility For 12 Continuous Months

The eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for children under the age of 19.

9. Benefits Begin First Day Of Month Using Plan Of Care Date

10. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

11. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client does not complete review. Client dies. Client determined no longer eligible.

Defining Group: 42 CFR 435.217

Social Security Act §1902(a)(10)(A)(ii)(xv)

Social Security Act § 1902(e)(12)

Income: 42 CFR 435 Subpart K

Resources: 42 CFR 435 Subpart L

The Medicaid Waiver System will send notification.

Clients Pay No Patient Contribution.

Clients under age 19, discharged from the Waiver, may have eligibility for the remainder of the 12 continuous months.

Determining Countable Income

1. Refer to Section M901 to determine if income is countable.

Determining Countable Resources

1. Refer to Section M801 to determine if resources are countable.

Calculating Nonexempt Resource Transfer Penalty

1. Refer to Sections M803 and M804 for information on transferring nonexempt resources and related penalties.

Accessing Waiver System to Determine Eligibility

1. Access the Medicaid Waiver System to determine status of the waiver process and verify the ICF-MR level of care requirement has been met.

1A. Log into Medicaid Waiver System by Clicking on the "Waiver System" tab in ECOM or access at https://waivers.health.wyo.gov .

1B. Enter your user name and password. Click on the "Log In" button.

1C. Review the Confidentially Agreement, Check the box indicating that you agree, and Click on the "Continue" button to proceed. This agreement must be completed the first time you log into the system and is required again every 45 days.

2. Complete assigned tasks for applicants who are in the Medicaid Waiver System and meet the eligibility requirements.

2A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you on what action needs to be completed.

2B. View , under Eligibility, a check mark by Complete LT-104 verifies the ICF-MR level of care requirement.

2C. The system will show Eligibility under Process and Financial Eligibility as the Status:

2Ci) Click on Has met the income and resource eligibility requirements .

2Cii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

2D. The system will communicate the eligibility determination and place the individual on a waiting list.

2E. Enter the Waiver Type and Pending Date in WES on the Waiver Information screen until a Plan of Care is approved and a start date is provided through the Medicaid Waiver System.

2F. Finalize on the Preliminary Determination Summary screen as eligible when the individual meets all eligibility requirements. WES will pend the case and generate a notice.

3. Complete assigned tasks for applicants who are in the Medicaid Waiver System and do not meet the eligibility requirements.

3A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you to complete the required actions.

3B. View the Status, Financial Eligibility or Confirm Financial Eligibility :

3Bi) Click on Has been denied financial eligibility .

3Bii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

3C. The System will communicate the eligibility determination and notify the waiver program of the denial.

4. Complete a search for an existing waiver client who is being closed or an applicant who is on the waiting list who is being denied.

4A. Click on the "Search Cases" tab.

4B. Fill in any combination of information to find a client.

4C. Click on the "Search" button.

4D. Click on the "View" icon next to the client's name.

4E. Click on the drop down menu to select a reason for accessing this case and Click "Save."

4F. Enter closure or denial reason, the date the client was notified and the effective date of the closure or denial.

4G. Click "Close."

5. Receive notification from the Medicaid Waiver System when an applicant has a funding opportunity.

5A. Redetermine financial eligibility if 60 days has passed since initial application.

5B. Access the Medicaid Waiver System.

5C. View the Process, Funding Opportunity and Status, Confirm Financial , found under your assigned tasks.

5Ci) Click on Has met the income and resource eligibility requirements or

5Cii) Click on Has been denied financial eligibility .

5Ciii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

5D. Notification will be sent from the Medicaid Waiver System with the approved Plan Of Care start date.

Authorizing Cases in WES

1. Complete updating resources and income in WES in the month of application and the first month of waiver eligibility forward to maximum benefit month.

Determining Continued Eligibility If Client Loses SSI

1. Require application.

2. Determine continued eligibility.

3. Finalize the new program type in WES and authorize benefits when the client meets all eligibility requirements.

4. WES will automatically generate an approval notice.

Approving Benefits

1. Update the Waiver Information screen in WES with the Plan of Care Date.

2. Finalize eligibility and authorize benefits when the client meets all eligibility requirements.

3. WES will automatically generate an approval notice.

4. Access the Medicaid Waiver system to communicate the eligibility determination.

Denying Benefits

1. Finalize eligibility and deny benefits in WES when the applicant is not eligible.

2. WES will automatically generate an approval notice.

3. Access the Medicaid Waiver System to communicate the eligibility determination.

Reviewing Cases

1. Refer to Section M1403 for information on reviewing cases.

Approving Cases For Remainder Of The 12 Continuous Months Period

1. Finalize the 12 Month Continuous Waiver program in WES and authorize benefits, beginning in the month after a child under the age of 19 is found ineligible.

2. WES will automatically generate a closure notice for the waiver services and approval for the 12 Month Continuous Waiver group.

Closing Cases

1. Finalize eligibility and close benefits in WES when the applicant is no longer eligible.

2. Allow 15-Day closure notice when an adverse action has occurred. WES will automatically generate the closure notice.

3. Access the Medicaid Waiver System to communicate the eligibility determination.

Current Policy Effective Date: August 1, 2025

Date Last Reviewed:

Previous Policy: January 1, 2022

POL M1002B2: DETERMINING ELIGIBILITY FOR ACQUIRED BRAIN INJURY WAIVER

1. Applicants Must Meet Basic Eligibility

Refer to Section M600 for information on basic eligibility factors.

2. Applicants Must Meet Medical Necessity Requirement

3. Applicants Meet Disability Requirements

Applicants meeting Medical Necessity Requirement fulfill the disability requirement.

4. Applicants Must Be Age 21 Through 64

Clients may continue to be eligible, beyond the age of 64, if they are eligible before their 65th birthday.

5. SSI Eligibles Do Not Need To Submit Application

If SSI is lost, an application will be required to redetermine eligibility.

6. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable. Provide an Income Trust Packet when the gross countable income is above the maximum income standard.

7. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Section M801 to determine if resources are countable.

8. Some Services Withheld For Nonexempt Resource Transfers

Nonexempt resources cannot be transferred for less than fair market value during the look-back period prior to application or when clients are receiving benefits.

Refer to Section M803 to determine if an resource transfer is exempt and to Section M804 for information on related penalties.

9. Benefits Begin First Day Of Month Using Plan Of Care Approval Date

10. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

11. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client dies. Client determined no longer eligible. Client does not complete review.

Define Group: 42 CFR 435.217

42 CFR 435 Subpart F

Income: 42 CFR 435 Subpart K

Assets: 42 CFR 435 Subpart L

SSI Eligibles Do Not Require An Application.

Client Pays No Patient Contribution.

Determining Countable Income

1. Refer to Section M901 to determine if income is countable.

Determining Countable Resources

1. Refer to Section M801 to determine if resources are countable.

Calculating Nonexempt Resource Transfer Penalty

1. Refer to Sections M803 and M804 for information on exempt resources and related penalties.

Authorizing Cases in WES

1. Complete updating resources and income in WES in the month of application and the first month of waiver eligibility forward to maximum benefit month.

Closing Cases

1. Send 15 day closure notice when an adverse action has occurred.

Current Policy Effective Date: August 1, 2025

Previous Policy: October 1, 2017

POL M1002C: DETERMINING ELIGIBILITY FOP CHILDREN'S MENTAL HEALTH WAIVER

1. Applicants Must Meet Basic Eligibility

Refer to Section M600 for basic eligibility factors.

2. Applicants Must be Age Four Through Age 20

3. Applicants Must Meet Clinical Eligibility

The Wyoming Department of Health (WDH), Behavioral Health Division determines clinical eligibility.

4. Applicants Must Meet Disability Requirements

Applicants meeting the clinical eligibility fulfill the disability requirement.

5. Applicants Must Meet Income Requirements

Require countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A for income standards. Refer to Section M901 to determine if income is countable. Provide an Income Trust Packet when the countable income is above the maximum income standard.

6. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource standard. Refer to Medicaid Table 7 for resource standards. Refer to Section M801 to determine if resources are countable.

7. Services Withheld For Resource Transfers

Nonexempt resources cannot be transferred for less than fair market value during the look-back period prior to application or when clients are receiving benefits.

Refer to Section M803 to determine if a resource transfer is exempt and to Section M804 for information on related penalties.

8. Applicants May Have Eligibility For 12 Continuous Months

The eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for applicants under the age of 19.

9. Benefits Begin First Day Of Month Using Plan Of Care Date

10. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

11. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur: Client does not complete review. Client dies. Client determined no longer eligible. Client enters public institution. Client moves out of state. Client’s 12-month period ends and he or she is no longer eligible.

Defining Requirement: 42 CFR 435.217

Social Security Act § 1915(c)

1. Clients Pay No Patient Contribution.

2. Clients under age 19, discharged from the Waiver, may have eligibility for the remainder of the 12 continuous months.

Determining Best Estimates

1. Refer to Section M903 for information on determining best estimates.

Determining Countable Income

1. Refer to Section M901 to determine if income is countable.

Determining Countable Resources

1. Refer to Section M801 to determine if resources are countable.

Calculating Resource Transfer Penalty

1. Refer to Sections M803 and Section M804 for information on nonexempt resources and related penalties.

Accessing Waiver System to Determine Eligibility

1. Access the Medicaid Waiver System to determine status of the waiver process and verify the Clinical Eligibility requirement has been met.

Log into Medicaid Waiver System by Clicking on the "Waiver System" tab in ECOM or access at https://waivers.health.wyo.gov .

Enter your user name and password. Click on the "Log In" button.

Review the Confidentially Agreement, Check the box indicating that you agree, and Click on the "Continue" button to proceed. This agreement must be completed the first time you log into the system and is required again every 45 days.

2. Complete assigned tasks for applicants who are in the Medicaid Waiver System and meet the eligibility requirements.

Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you on what action needs to be completed.

View , under Eligibility, a check mark by the Clinical Eligibility requirement.

The system will show Eligibility under Process and Financial Eligibility as the Status: Click on Has met the income and resource eligibility requirements. Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

The system will communicate the eligibility determination and place the individual on a waiting list.

Pend the case in WES until a Plan Of Care is approved and a start date is provided through the Medicaid Waiver System.

Send a Pending Notice in WES when the individual meets all eligibility requirements

3. Complete assigned tasks for applicants who are in the Medicaid Waiver System and do not meet the eligibility requirements.

Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you to complete the required actions.

View the Status, Financial Eligibility or Confirm Financial Eligibility : Click on Has been denied financial eligibility . Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

The System will communicate the eligibility determination and notify the waiver program of the denial.

4. Complete a search for an existing waiver client who is being closed or an applicant who is on the waiting list who is being denied.

Click on the "Search Cases" tab.

Fill in any combination of information to find a client.

Click on the "Search" button.

Click on the "View" icon next to the client's name.

Click on the drop down menu to select a reason for accessing this case and Click "Save."

Enter closure or denial reason, the date the client was notified and the effective date of the closure or denial.

Click "Close."

5. Receive notification from the Medicaid Waiver System when an applicant has a funding opportunity.

Redetermine financial eligibility if 60 days has passed since initial application.

Access the Medicaid Waiver System.

View the Process, Funding Opportunity and Status, Confirm Financial, found under your assigned tasks. Click on Has met the income and resource eligibility requirements or Click on Has been denied financial eligibility . Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

Notification will be sent from the Medicaid Waiver System with the approved Plan Of Care start date.

Authorizing Cases in WES

1. Complete updating resources and income in WES in the month of application and the first month of waiver eligibility forward to maximum benefit month.

Closing Cases

1. Finalize eligibility and close benefits in WES when the applicant is no longer eligible